Inspection on 27/01/06 for Linden House

This inspection was carried out on 27th January 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 no outstanding requirements from the previous inspection report, but made 12 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 02/06/06

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 27th January 2006 10:00 Linden House DS0000033209.V265812.R01.S.doc Version 5.0 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.V265812.R01.S.doc Version 5.0 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.V265812.R01.S.doc Version 5.0 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.V265812.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th September 2005 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 recently 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 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.V265812.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took approximately seven hours. The manager was present or available throughout the inspection although regrettably this was his last day in post at this home. The provider organisation’s Supported Living Manager, who has overall line management for the home, attended the home during the inspection and this was helpful. There were five service users accommodated at the time of the inspection and one vacancy. The inspection included: meeting and observing the five service users accommodated although communication was limited by their complex communication needs; a brief independent discussion with a visiting relative; independent discussion with five care staff, one in some detail and discussion with the home’s manager and the visiting manager from the provider organisation. 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 previous inspection was undertaken following significant refurbishment to the physical environment, with no service users being accommodated at that time and before the new manager and staff team had taken up their posts. There were seventeen requirements made at that time that were effectively related to the final snagging work following the major refurbishment, much of which had been already identified by the registered provider. Seven of these related to ensuring the environment met the national minimum standards, anther eight were similar although had health and safety implications, one related to the new manager registering with the CSCI and one specifying that a valid third party liability insurance certificate was displayed in the home. The Linden House DS0000033209.V265812.R01.S.doc Version 5.0 Page 6 inspector was pleased that all of these had been complied with or were no longer relevant. 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.V265812.R01.S.doc Version 5.0 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.V265812.R01.S.doc Version 5.0 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 Prospective service users have accessible information to allow them and other relevant stakeholders to make informed choices about living at the home. Service users needs and aspirations are assessed at the time of admission to allow the home to develop strategies to meet these. The assessment process continues following admission to allow the home to continue to refine sensitive and appropriate methods of intervention to further support service users in meeting their needs. EVIDENCE: The home has a satisfactory statement of purpose and accessible service user guide that have both been revised to reflect the service currently offered following the changes made during the refurbishment of the home. A copy of the revised statement of purpose was given to the inspector and the service user guide was also seen with evidence that these had been distributed to service users. Both documents will need a further amendment once a new manager has been appointed to the home to show that person’s details. Three service user files were inspected and each showed a satisfactory range of assessment information that was available to the home on their respective recent admissions to the home. Evidence was seen that the manager and staff had been involved in obtaining a significant amount of this information and had visited some service users in their previous living environments. All threeservice users had complex needs and evidence was seen that on going work was being undertaken to refine the assessment information available. An Linden House DS0000033209.V265812.R01.S.doc Version 5.0 Page 9 example of this were revised risk assessments for all the five service users accommodated relating to access to the kitchen and its equipment. These were undertaken in mid January 2006 and copies sent to the inspector at the time for information. Linden House DS0000033209.V265812.R01.S.doc Version 5.0 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 Service users needs are well recorded in their care plans and guidance for staff included on how to best support service users in meeting these needs. The home also has a service user review policy that will identify changing needs to ensure that these can continue to be met. The home is working hard to enable service users to make as many choices and decisions for themselves as possible. Service users are also supported to take appropriate risks in their day-to-day lives to maximise their independence. EVIDENCE: Each of the three service user files inspected contained detailed care plans that directly related to the assessed needs of that individual. The inspector was informed that the intention of the home was to work with service users and stakeholders to develop a person centred approach to care planning. Evidence of this was seen on one of the service user files inspected. The manager stated that this was the first person centred plan being developed, as this service user was the only one accommodated at the time who was verbal. He went on to say that this assisted the process although it was the intention of the home to develop person centred plans for all the service users over a period of time. The stated policy of the home is to review care plans at least three monthly, all Linden House DS0000033209.V265812.R01.S.doc Version 5.0 Page 11 the care plans were under three months old at the time. A range of risk assessment information also informed the care plans. Some of this was in the form of general risk assessments that identified risk areas, which people were potentially at risk, possible triggers that may exacerbate the risk and risk management/ prevention strategies. Other risk assessments seen where specific to individuals and their given circumstances and included specific behavioural guidelines. Evidence was seen that the manager had worked hard to obtain the assistance of psychology and other health professionals including speech and language therapists to assist in this task. The inspector considers ongoing support to staff from health and social care professionals is essential given the complex needs of the service users accommodated and this will need to continue to be monitored at future inspections. There was a range of restrictions relating to service users opportunities to make decisions in their day-to-day lives because of their varying complex needs. These restrictions were seen to be appropriately recorded and staff spoken to were aware of why the restrictions had been imposed and had an understanding of the context in which these operated. This included specifying which tasks or activities service users must have direct staff support with. The recent risk assessments relating to access to the kitchen, referred to in the Choice of Home section of this report, provided a good example of how these restrictions were agreed and recorded. The home assists service users administer their finances including by the home keeping their savings books where appropriate and assisting them with their personal allowances. Records of personal finances for two service users were sampled and were found to be satisfactory. The inspector was also shown guidance for staff that the home used in assisting with service users finances and also a cash risk assessment that had been carried out in November 2005. Both of these were also satisfactory. Evidence was seen that risk was assessed at the time of service users admission to the home and that this was continuing to be closely monitored. As stated above detailed risk assessments were used to inform care plans and where appropriate more detailed behavioural guidelines for individual service users. Linden House DS0000033209.V265812.R01.S.doc Version 5.0 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): 12,13,14, 15, 16 & 17 The home is working hard to develop a range of appropriate activities for service users both inside and outside the home although further work is needed in this area to ensure that all service users can enjoy these. Service users are supported to develop and maintain relationships with relatives and others to the extent that they wish. Service users are also treated with respect, supported to make appropriates choices and take as much control over their daily lives as they are able to. Service users enjoy a range of meals of their choice although an identified improvement to the kitchen equipment is needed to further support this process. EVIDENCE: As the home has recently opened and as the needs of the service users accommodated are complex, developing appropriate activities and opportunities for service users is still ongoing. Two of the five service users accommodated attend external day services and the inspector was informed that they enjoyed this. Evidence was seen that another service user had been supported by the home to enrol at a local college and would be supported by the home’s staff to attend this shortly. However, the other two service users Linden House DS0000033209.V265812.R01.S.doc Version 5.0 Page 13 had no structured daytime activities at the time and a requirement is made that these must be developed. There was evidence that the home is trying to support service users with leisure activities with two service users being supported to attend a club run on a Monday at another Haringey social service facility. One service user is also supported to go swimming and to use a trampoline at other local facilities. The home had a range of indoor games and recreational resources that the inspector saw and observed one service user being supported to utilise these during part of the inspection. Service users are also supported to access the local community where appropriate including the local shops and park. One service user went to make some purchases for themselves accompanied by a member of staff during the inspection. This service user was enthusiastically engaged in the process of signing out the required amount from their individual cash box that staff use to assist the service user keep their money safe. All but one of the service users had regular contact with relatives and the relative of one was briefly spoken when they visited the home during the inspection. This relative had made a complaint to the home regarding an identified aspect of support to his service user and evidence was seen that this was being appropriately dealt with using the home’s complaints procedure. The relative told the inspector that he visited the home very regularly and was sorry that the manager was leaving after such a short time. Interaction between service users and staff was observed during the inspection and was seen to be respectful and individualised. Four of the five service users were non-verbal and the inspector was impressed by the way that staff communicated and interacted with them. For the most part the service users responded positively to staff attention and staff were seen to act appropriately if it was perceived that a service user was getting frustrated or angry at a particular occurrence. One member of staff told the inspector that the new staff group had had to learn new skills quickly and that the job could be very demanding at times. The home was operating a four-week menu that specified an appropriate range of meals. The manager stated that a task identified to be undertaken was to develop a pictorial menu to assist service users both contribute to developing the menu and making choices from it on a daily basis. The inspector was informed that care staff cook the meals and staff were observed cooking the lunch appropriately during the inspection. It was noted however that the majority of the staff had not undertaken food hygiene training and a requirement is made regarding this in the Staffing section of this report. Staff were also observed interacting with service users about lunch on the day including trying to ascertain if an individual would prefer an alternative to the scheduled meal. Again, staff were observed doing this respectfully and creatively with non-verbal service users. Service users observed appeared to Linden House DS0000033209.V265812.R01.S.doc Version 5.0 Page 14 enjoy their lunch. The home had a satisfactory range of food that was stored appropriately. The inspector was pleased to see that the home had purchased a new fridge and new freezer as required at the last inspection. Satisfactory daily temperature records were seen in respect to both of these. The inspector was informed that the cooker in the kitchen had a range of faults including the ignition mechanism not functioning properly. Staff also stated that the cooker was generally large, institutional and difficult to operate. A requirement is made that the cooker is either replaced or repaired to ensure that it works correctly and meets the needs of service users and the home. Linden House DS0000033209.V265812.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Service users receive personal care in a sensitive way and which meets their needs. Service users also receive appropriate support in meeting their health needs although the home must undertake further work to ensure that two identified service users are registered with a GP. The home has generally safe procedures for assisting service users with the administration of their prescribed medication although an improvement is needed in an identified area. EVIDENCE: As indicated in the Lifestyle section of this report staff have developed effective ways of communicating with the non-verbal service users who appeared comfortable in their observed interaction with staff. The staff support and assistance that individual service users need is well documented along with guidance to staff on the service user’s preferences regarding their personal care. The majority of the service users accommodated need considerable physical assistance with their personal care and staff spoken to could describe how they undertake this appropriately. Three of the service users were registered with a local GP but two were not. The inspector was told that this was primarily because the two service users were extremely reluctant to attend the GP’s surgery to register. Taxi’s had Linden House DS0000033209.V265812.R01.S.doc Version 5.0 Page 16 been ordered and staff had used their significant communication skills but to no avail. The inspector was told that the GP would not visit the service users in the home in order to register the individual. A requirement is made that the home formally requests the local primary care trust to assist resolve this matter. A range of relevant information was available regarding the health of service users from the files inspected; this included detailed guidance on the management of epilepsy for two identified service users. One service user had been identified as needing some dental work and has been referred to a local community dentist via the combined health and social service’s learning team, to assist with this. All five service users were being assisted by the home with the administration of their prescribed medication and the medication and medication administration record (MAR) chart for two of the service users were inspected at random. Medication was supplied by the dispensing pharmacist in blister packs where appropriate and in other suitable containers where this was not appropriate. The medication and MAR charts were generally satisfactory although a further improvement in recording is needed with regard to PRN medication, that is medication that is to be given when required. It was not possible to follow a robust enough audit trail of this medication because the signing in and return of this medication did not correspond with the actual amount of this medication stored when inspected. A requirement is made regarding this. There were satisfactory guidelines regarding when this medication was to be administered and who was to be informed when it needed to be administered. All the medication seen was appropriately stored in a locked medication cupboard. Evidence was seen that staff training in the safe administration of medication had been provided since the home had reopened. Linden House DS0000033209.V265812.R01.S.doc Version 5.0 Page 17 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 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 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 details required in this standard including the details of CSCI. The home was dealing with one complaint from a relative of a service user and written evidence seen that this was being dealt with in accordance with the procedure including arrangements being made for follow up meetings with the relative. The relative, who visited the home during the inspection, also confirmed this. The manager stated that no other complaints had been received by the home since it reopened. The home also had a satisfactory adult protection policy and in-house guidance for staff, which were both seen. The home also had a copy of the adult protection procedure for the local authority the home is situated in. The manager was able to discuss the types of action that may be necessary should an allegation or disclosure of abuse be made. On further discussion with the manager, staff and from training documentation it was noted that none of the care staff had undertaken any basic training on adult protection and a requirement is made regarding this in the Staffing section of this report. Linden House DS0000033209.V265812.R01.S.doc Version 5.0 Page 18 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, 26, 27, 28 & 30 Service users live in a home that has been recently refurbished, is comfortable, well decorated and well maintained. The home was clean and tidy throughout creating a pleasant environment for those that live and work at the home as well as for those that visit it. EVIDENCE: The physical environment of the home underwent major refurbishment work during 2004/ 05. At the last inspection in September 2005 the major building work had been completed although the service was not open at that stage. During that inspection seven requirements were made to ensure that a variety of snagging work, which in the inspector’s view is almost inevitable after this sort of major refurbishment, was completed. These related to minor work to be finished in relation to: being able to lock the boiler room, the front garden gates, checking of a crack in the front wall of the home, furniture in service user bedrooms, individual temperature control on radiators, equipment in the kitchen and deep cleaning the kitchen. The inspector was pleased to see that all of these had been complied with. The home provides a safe and comfortable environment for service users to live in. Linden House DS0000033209.V265812.R01.S.doc Version 5.0 Page 19 The home was clean and tidy throughout on the day of the inspection. The home had appropriate laundry facilities situated on the first floor that were seen and satisfactory infection control procedures were being operated. Linden House DS0000033209.V265812.R01.S.doc Version 5.0 Page 20 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 The home has an effective staff team, in sufficient numbers, to support service users and to assist in meeting their assessed needs. Further work is needed to evidence that service users are protected by robust staff recruitment procedures. Staff are offered a wide range of relevant training to assist them in their own personal development and in meeting service users needs. However, staff need to be able to access further training opportunities to allow them to acquire the professional qualification required. Staff are also well supervised and supported to further enable them to develop their own potential that also contributes to their ability to meet service users needs. EVIDENCE: There are nine full time support worker posts and four team leader posts established at the home. Two of the support worker posts and one team leader post were vacant at the time of the inspection. The inspector was informed that one support worker had achieved the national vocational qualification (NVQ) level 2 in care and one team leader NVQ level 3 in care. The inspector was also informed that four other staff had been identified to be put forward for NVQ training but the manager was not clear that all four could be released to undertake this qualification. It is a national minimum standard that a at least 50 of care staff are qualified to at least NVQ level 2 in care and it is Linden House DS0000033209.V265812.R01.S.doc Version 5.0 Page 21 required at this inspection that nominations are confirmed for additional staff to achieve this qualification in order to meet the 50 minimum required. The staff rota inspected showed the following minimum number of staff on duty: one team leader and three support staff early shift, one team leader and three support staff late shift and two waking and one sleeping-in staff at night. The staff on duty during the inspection matched those recorded on the rota. The whole staff group had taken up post in October 2005 after which the service re-opened to accommodate service users at the end of 2005. Evidence was seen to indicate that all staff employed had satisfactory criminal record bureau (CRB) clearances including protection of vulnerable adult (POVA) checks. Copies of the majority of these were seen with confirmation also seen from the Haringey Social Services Human Resource department of the CRB numbers and dates they were issued for the remaining staff. Three staff files were inspected at random and generally showed evidence of a robust recruitment procedure. Copies of the majority of the documentation to evidence this was seen although one staff file did not contain evidence of satisfactory proof of identity and another only contained a copy of one reference instead of two. The manager stated that he believed that all the required documentation had been seen at the time of appointment but that it was sometimes difficult to get copies of all of this from Haringey’s Human Resources department. A requirement is made that a copy of all the required documentation is kept in the home. The manager had developed a system for monitoring what training staff had undertaken and that which is still required. Training undertaken by staff since the home reopened included moving and handling, managing challenging behaviour, dealing with epilepsy and safe administration of medication. Outstanding required training for identified staff included food hygiene, adult protection, fire safety, infection control, first aid and health and safety; a requirement is made regarding this. Evidence was seen from records randomly sampled that staff had undertaken effective induction training. Staff spoken to confirmed this. Evidence was also seen that staff receive monthly supervision and staff spoken to confirmed this and that the supervision was useful to them. Linden House DS0000033209.V265812.R01.S.doc Version 5.0 Page 22 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 & 43 Service users have benefited from a well managed home to date. However, future management arrangements for the home need clarifying and establishing given imminent changes that will occur to these, to ensure that service users continue to benefit from a well run home. A good start has been made to the monitoring of the quality of the service provided to service users at the home and in identifying further improvements that they will benefit from. Service users benefit from a clear commitment to health and safety at the home although further identified improvements need to be addressed in this area. Adequate insurance cover is in place to ensure that service users, staff and visitors to the home are properly protected. EVIDENCE: The registered provider had appointed a new manager to the home who had started at the home when it reopened and undertaken a significant amount of work to start up this effectively new service. Regrettably, the day of the inspection was the manager’s last day of employment with the registered Linden House DS0000033209.V265812.R01.S.doc Version 5.0 Page 23 provider as he had obtained a new post. It is the inspector’s view that this leaves the service potentially vulnerable given the complex needs of the service user and that the staff team, which is also newly appointed, is still in the process of developing effective professional relationships with each other and with the service users and their families. A requirement is made that the home appoints a new manager, that the person appointed to the post applies to be registered as the home’s manager with the CSCI and that the registered provider informs the CSCI of the interim management arrangements for the home. The inspector was also met the L.B. of Haringey’s Supported Living Service Manager who has line management responsibility for a range of learning disability services including Linden House. The inspector was pleased that this manager had attended for part of the inspection, which was helpful. However, the inspector was concerned to learn that the registered provider’s nominated responsible individual for the home had also left their post during 2005 and the CSCI did not appear to have been notified of this. A requirement is made that the registered provider nominates another responsible individual for the home and formally notifies the CSCI of the change. It was clear from a range of documentation seen at the home that the manager had coordinated a range of contact with service user’s relatives and other stakeholders of the service since he had been in post. From this he had compiled a list of improvements for the registered provider that identified a range of improvements that in his opinion still needed to be carried out at the home during the first half of 2006. This list had been given to the Supported Living Service Manager and a copy was given to the inspector at this inspection. This list effectively forms a development plan for the unit and the inspector looks forward to learning how progress is made in achieving the improvements identified. The Supported Living Service Manager had undertaken the required monitoring visits to the home since it had reopened and copies of the reports of these had been sent to the CSCI. At the last inspection a number of health and safety requirements were made in relation to work still to be completed following the physical refurbishment of the building. This was a similar process to improvements referred to in the Environment section of this report. The requirements made related to: minimising the danger of legionella, portable appliance checks, ensuring that thermostatically controlled valves used to control water temperature were working effectively, ensuring the valves fitted were covered, an extractor fan in an internal toilet, adjusting identified fire door closures, servicing fire fighting equipment, ensuring the home had a satisfactory fire plan and fire risk assessment and that the fire officer was consulted on these. The inspector was pleased that these requirements had been complied with. During the tour of the building it was noted that a fire door on the first floor corridor was wedged open as a result of a recent incident involving a service Linden House DS0000033209.V265812.R01.S.doc Version 5.0 Page 24 user where the handle had been broken and the door could not be easily opened once closed. It was also noted that a self-closing mechanism on the ground floor main lounge fire door had also been broken recently following an incident involving a service user. Evidence was seen that both of these items had been reported to the registered provider’s maintenance department as a high priority but had not yet been repaired. A requirement is made regarding these. The home’s fire risk assessment had been submitted to the fire officer as required at the last inspection. The fire officer had subsequently visited the home and made further written requirements in relation to the fire risk assessment and had also indicated in writing a timescale by which these must be complied with and that he would undertake a follow up visit. The manager believed that the improvements needed to the fire risk assessment had been made but the fire officer had not undertaken his follow up visit although the timescale had passed. A requirement is made that the home must obtain written confirmation from the fire officer that the fire risk assessment is now satisfactory. In the last monitoring visit to the home it was indicated that fire drills needed to be carried out more regularly at the home. The manager informed the inspector that carrying out conventional fire drills, whereby the fire alarm was sounded and service users supported to evacuate the building, was extremely disturbing to service users. The manager went on to say that when this had been tried it had provoked a range of challenging behaviour from service users that was distressing for them and distressing for staff in trying to deal with this. A requirement is made that the home consults with the fire officer and obtains written agreement from him regarding revised fire drill procedures that minimise harmful disruption to the service users. A requirement was made at the last inspection that a current public liability insurance certificate is displayed in the home. This was seen to have been complied with. Linden House DS0000033209.V265812.R01.S.doc Version 5.0 Page 25 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X 3 3 3 X 3 LIFESTYLES Standard No Score 11 X 12 2 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 3 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Linden House Score 3 2 2 X Standard No 37 38 39 40 41 42 43 Score 2 X 3 X X 2 3 DS0000033209.V265812.R01.S.doc Version 5.0 Page 26 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA12 Regulation 16(2m&n) Requirement The registered provider must ensure that structured daytime activities are identified for two service users and that they are supported to participate in these activities. The registered provider must ensure that the defective cooker in the home is either repaired or replaced. The registered provider must ensure that liaison takes place with the local primary care trust to ensure that two identified service users are registered with a GP. The registered provider must ensure that there is a clear audit trail for PRN medication prescribed to service users that includes a record of medication entering and leaving the home. 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. Timescale for action 31/03/06 2. YA17 23(2c) 31/03/06 3. YA19 13(1) 28/02/06 4. YA20 13(2) 28/02/06 5. YA32 18(1a&c) 31/03/06 Linden House DS0000033209.V265812.R01.S.doc Version 5.0 Page 27 6. YA34 17(2) 7. YA35 18(1c) 8. YA37 8 9. YA37 39 10. YA42 23(4) 11. YA42 23(4) 12. YA42 23(4) 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 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. The registered provider must: ensure that a new manager is appointed to the home, that the person appointed to the post applies to be registered with the CSCI as the home’s registered manager and that by 28/02/06, the registered provider informs the CSCI in writing of the interim management arrangements for the home. The registered provider must ensure that the CSCI is notified of the change to the responsible individual for the home. The registered provider must ensure that repairs are carried out to two identified fire doors, one in the first floor corridor and the other in the ground floor main lounge. The registered provider must ensure that written confirmation is received from the fire officer that requirements made by him to improve the home’s fire risk assessment have been complied with. The registered provider must ensure that the home consults with the fire officer and obtains written agreement from him regarding revised fire drill DS0000033209.V265812.R01.S.doc 28/02/06 31/03/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 Linden House Version 5.0 Page 28 procedures that minimise harmful disruption to the service users. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Linden House DS0000033209.V265812.R01.S.doc Version 5.0 Page 29 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. 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