Inspection on 09/07/07 for Linden House

This inspection was carried out on 9th July 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 23/01/07

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 9th & 11th July 2007 09:00 Linden House DS0000033209.V333282.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.V333282.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.V333282.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 ** Post Vacant *** Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd January 2007 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 people 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, a separate toilet and staff facilities. The first floor, which is not accessible to wheelchair users, contains six residents 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 people living at the home. 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 people 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 people living there 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 people living there 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.V333282.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 eight hours over two days with the manager, Ms Noray Ahmet, being present on the second day. There were five people living at the home at the time of the inspection and one vacancy. The home had admitted one new person since the last inspection. The inspection included: meeting the five people living at the home during the inspection although meaningful communication was very limited because of the communication needs of the five people; detailed discussion with the manager; independent discussion with two team leaders; discussion with five support workers, two of them independently; a brief discussion with the administrator and an independent discussion with a senior manager from the provider organisation who visited the home on the first day of the inspection. I had also attended a meeting with one relative and other stakeholders involved with one person living at the home prior to the inspection. Further information was obtained from a tour of the premises and documentation kept at the home. What the service does well: The home is working hard to meet the very complex needs of people living there, including people’s severe communication difficulties. Staff have access to a range of health and social care professionals to assist them in this work. The home supports and encourages people living there to make a range of informed choices about their day-to-day lives to the extent to which they are able. People living at the home come from a range of differing cultural backgrounds and the home continues to help them understand and celebrate these. Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 8 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.V333282.R01.S.doc Version 5.2 Page 9 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The needs of people referred to the home are assessed to ensure that the home can meet their needs. Once admitted people’s needs continue to be reviewed to assist the home to meet their changing needs. EVIDENCE: One new person had recently been admitted to the home. This person was transferred from another home run by L.B. Haringey’s learning disability services. Evidence was seen on the person’s file of a range of up to date assessment information that was available to the home before their admission to the home. The manager explained how the admission process worked including staff visiting the person in their previous placement and the person visiting the home before admission. The home has recently developed a photograph album showing pictures of the home and people living there undertaking a range of activities. This is now used to supplement other information about the home, to assist people who are non-verbal or have other communication needs, to have an insight into what living at the home may be like before they move in. The photograph album is in both hard copy and on CD and the manager stated that this had been used very successfully during the admission process for this latest person to be admitted to the home. Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 10 The files of two other people were inspected. These showed that people’s needs were reviewed on a regular basis to ensure that their changing needs were known to the home. For one person in particular there was evidence of a significant amount of assessment information that had been gathered since the last inspection. This had involved input from a range of health and social care professionals and evidence was seen of ongoing input from those professionals as a result of the assessments. The home still had one vacancy at the time. The manager was aware of the importance of introducing new people to the home on a planned basis. This is to ensure that the new person settles with minimum disruption both themselves and to the existing people living at the home. Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 11 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments are kept up to date to assist staff be aware of people’s changing needs and to give up to date guidance on how to effectively address these changes. Staff are working hard to assist people make as many decisions for themselves as they can about their day to day lives although further independent input may assist in promoting one person’s independence. EVIDENCE: The files of three people living at the home were inspected. At the last inspection a requirement had to be restated that all reviews and evaluations of people’s care plans were signed and dated by the person undertaking the review to evidence these were up to date. I was pleased to see that this requirement was now being complied with. The care plans seen contained relevant detail and were informed by up to date assessment information, Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 12 including risk assessment information. The home operates a key worker system with evidence seen that key workers are involved in reviewing the plans. Two of the plans were supplemented by more detailed guidance for staff where appropriate. These included personal care guidelines, controlling epilepsy guidelines and behaviour management guidelines. Although the above-mentioned guidance and the care plans were both together on the file, a good practice recommendation is made that where appropriate, the additional staff guidelines are more clearly cross-referenced with the care plan. This is to ensure that staff, particularly agency staff, are aware of both documents. All of the five people living at the home at the time of the inspection had significant support needs regarding communication. Staff were working hard to assist people in communicating their wishes and to make decisions regarding their daily lives. One example of this was that the home has continued to develop a range of photographs including of a drink, a meal, an electric shaver and a range of other relevant objects to assist one person communicate their needs. The photographs are displayed on a board in the home and also contained in a book that staff can take out of the home with the person. The manager stated that the person would sometimes initiate using the photographs to indicate their wishes rather than just responding after being prompted by staff to do so. She went on to say that this progress had been made since the last inspection. The home operates a key worker system that staff stated was helpful in ensuring that a clear overview was kept of people’s 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 dining room with a designated “sign for the week” being displayed. The behaviour of one person living in the home was challenging the service and the home was endeavouring to find an independent advocate to assist in addressing this. Evidence of referrals to two independent advocacy organisations was seen but the organisations had recently declined to work with the person for differing reasons. The manager stated that this was being referred to more senior managers in L.B. of Haringey, the provider organisation, as the Borough commissions advocacy services for people from vulnerable groups, including people with a learning disability. A good practice recommendation is made that the provider organisation continues to seek an independent advocate for this person. All of the people living in the home have some limitations imposed on them relating to keeping them safe. Evidence was seen that these limitations were agreed and monitored through the assessment process and recorded in the person’s care plans. Each of the three people’s files inspected contained up to date risk assessments. At the last inspection a requirement had to be restated that all reviews and evaluations of people’s risk assessments were signed and dated by the person undertaking the review to evidence these were up to date. I was Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 13 pleased to see evidence that this requirement was now being complied with. Staff spoken to were aware of identified risks and the current guidance on how to minimise these. During the inspection staff were observed implementing the guidance as described in both the risk assessments and in relevant behaviour management guidelines. Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 14 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home have access to increased resources to assist them participate in appropriate activities including within the local community. They also benefit from clear efforts being made to assist them relate to their cultural origins. Contact with relatives is promoted and encouraged, which people living at the home benefit from. Their rights are responsibilities are respected and promoted within their daily lives. People also enjoy healthy and ethnically appropriate meals although would still benefit from the kitchen being cleaner. EVIDENCE: Each of the five people living at the home had a weekly programme of activities displayed in the dining room. All five people 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. People were attending the day services as shown on their programme during the inspection. A range of Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 15 other activities was also shown for each person and these were undertaken both in the home and in the local community. These were mainly individual activities undertaken with staff support and included visiting a library, going to a pub, going to the cinema, going to the park, attending a club on a Monday and one person attending a weekly trampoline session in a community setting. The home continues to have and an additional dedicated 72 staff hours allocated to facilitate residents accessing the community. This is on a one-toone basis or with two staff accompanying one resident where this is necessary to support the person. The manager confirmed that the additional 72 hours could be used flexibly including at weekends and evenings. A senior manager from the provider organisation who visited during the inspection stated that the funding for the 72 additional staff hours was now incorporated into the home’s permanent budget. She stated that this meant that the home should be able to recruit staff to these hours on a permanent basis. The manager stated that the home was still able to access a minibus from L.B. Haringey at the weekends to assist arrange other outings in the community and evidence of this was seen from documentation in the home and from staff spoken to. The home is planning to hold a BBQ in August for people living at the home, their relatives, friends and other stakeholders. The manager and staff continue to promote and celebrate the cultural diversity of both people living in the home and of staff. There is a large world map in the dining room with stickers indicating the parts of the world where people who use the service, their families and staff originated. One staff member spoken to stated that they had completed a project to compile a CD that contained tracks of music representing the countries of origin of staff. This included music from Ghana, Cyprus, Albania, Kenya, Sierra Leone, the Caribbean and Nigeria and that this should be available to the home soon. Four people living at the home have regular contact with relatives. This includes relatives visiting the home and people living there visiting and staying with relatives. The fifth person does not have contact with relatives. The manager has arranged a series of monthly meetings at a weekend for relatives throughout 2007 and minutes of these meetings were sampled. They showed evidence of discussion, information giving and seeking the views of relatives on a range of subjects relating to the home. It was noticed that relatives’ attendance at these meetings was variable and that the manager was asking them if different times would be more suitable. Staff were seen to interact sensitively and appropriately with people living in the home including communicating with them using a combination of makaton signs and other means of verbal and non verbal communication. There remain a number of appropriate limitations placed on all the people accommodated and details of these were seen recorded on files inspected. The home is continuing to develop its menu to promote both healthy eating and to incorporate a more ethnically diverse range of meals. Evidence was Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 16 seen of consultation with relatives about meals and the menu was seen to include dishes such as Jamaican jerk chicken, Nigerian beef jallof and lamb curry. One member of staff was due to give a cookery demonstration for a particular meal. The home was developing mechanisms for giving people living in the home more options relating to meal times. This included laying out choices of cereal for people to allow them to physically choose and help themselves to what they wanted for breakfast. This was to give them more autonomy in choosing rather than indicating to staff what they wanted and having it served for them. Given the complex needs of people this is a significant step forward and one person, who had chosen to have a late breakfast, was seen to enjoy the ability to help themself to what they wanted, with staff support. Food was appropriately stored and health and safety records relating to the kitchen were seen to be up to date and satisfactory. At the last inspection a requirement was made that the kitchen be deep cleaned as the upper walls and ceiling were greasy my judgement was that this presented a potential health and safety hazard. This requirement had not been complied with and is restated. Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 17 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 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home receive appropriate personal support in accordance with their needs and preferences. The home is working hard to appropriately address people’s mental and physical healthcare including through referrals to a range of community based health professionals. The system for administering medication to people needs to be improved and reviewed in identified areas to minimise the risk of incorrect administration. EVIDENCE: All of the people 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 appropriate personal care in the way that people prefer. This included that personal care was provided in a way that met people’s cultural needs. Each shift has at least one female member of care staff on duty to ensure that all people accommodated can access sensitive and gender specific personal care. One person has particularly complex needs regarding their Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 18 personal care and with their health needs generally. Evidence was seen of the involvement of a range of health care professionals to assist the staff meet these needs and of updated personal care guidelines for staff relating to this person. Evidence was seen that the physical and emotional health needs of people living in the home continue to be taken seriously. All people accommodated are registered with a G.P. and evidence was seen of further contact with a G.P. practice close to the home to explore registering all the people accommodated to further improve the service they receive. Evidence was seen that people are supported to attend a range of appointments with relevant healthcare professionals as required. Evidence was also seen that people living at the home have access to specialist healthcare professionals including psychiatrists, psychologists and speech and language therapists. A good practice recommendation was made at the last inspection that health care action plans are completed for people living at the home in consultation with local health care professionals. This recommendation was made to try to assist staff proactively develop strategies for tackling the difficulties that can arise when a person with very complex needs has to access mainstream health services. Progress was being made regarding this and a health action plan for one person with complex needs was seen to have been compiled with the assistance of healthcare professionals. The health needs of one person remain complex and evidence of ongoing multi-disciplinary work was seen to assist the home in addressing these needs. Two requirements were made at the last inspection to improve the home’s safe administration of medication. The first was to ensure that medication administration record (MAR) charts fully recorded the directions for administering medication as supplied by the dispensing pharmacist. The second was to ensure a record was kept available for inspection regarding medication received into the home and medication disposed of. Evidence was seen that both of these were being complied with. Evidence was also seen that staff training in safe administration of medication was up to date. The medication and MAR charts for three people were inspected. The majority of medication for people living in the home is supplied via a monitored dosage system (MDS). This is in the form of blister packs with each dose of medication being supplied for the appropriate time of day for each day of the month. The medication is supplied in four weekly packs marked for the appropriate day of the week. However, the MDS medication inspected for two of people showed that the medication was not being administered in the proper sequence required in the MDS system. Although on the day medication was inspected it had been given from the blister pack marked for that day, medication was still in the pack for previous days for that week which could give the impression that medication had not been administered on those days. There was no record available as to why the medication had not been administered in the required sequence. When medication is administered two staff sign to witness this and Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 19 staff spoken to stated that they were clear the correct medication was and had been given. The MAR chart was also satisfactorily completed and initialled by two staff for each medication administered. However, as the medication was not being given in the correct sequence it was not possible to double-check this from the blister packs concerned. As all the people accommodated have limited communication and complex needs it is even more essential that medication is given in accordance with the system it is dispensed in and that this can be robustly audited. A requirement is made regarding this to minimise the risk of medication being administered incorrectly. One relative had expressed a separate concern since the last inspection about the system of administering medication to their person living in the home. At the time of this inspection a senior manager from the provider organisation was appropriately investigating this concern. However, a good practice recommendation is made at this inspection that the system of administering medication to this person is reviewed with their G.P. This is to investigate if the medication could be administered in a different way to minimise any risk of the medication not being properly swallowed by the person concerned. Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 20 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home and relatives are able to express their views and concerns and have these appropriately dealt. People living at the home are also protected by satisfactory adult protection policies and procedures that staff are aware of. EVIDENCE: A serious concern had been raised with the Commission about the care of one of the people living in the home. This is currently being formally investigated by the L.B. Haringey under their safeguarding adults (adult protection) procedures. 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 apart from the concern referred to above no other concerns of complaints had been received at the home since the last inspection. The home had a satisfactory adult protection procedure that was seen. The home also had a copy of the local authority procedure, the London Borough of Haringey’s, which is the local authority the home is situated in. The manager Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 21 stated that apart from the concern above that is being investigated L.B. Haringey, no other allegations or disclosures of abuse have been received by the home. Evidence was also seen that staff training in adult protection was up to date and staff spoken to were able to state what action needed to be taken should an allegation or disclosure of abuse be made to them. Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 22 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 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is generally comfortable and homely although continues to need more resources to ensure that it is decorated, maintained and equipped to meet their particular complex needs. The home was clean and tidy creating a 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 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 people living in the home. Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 23 The home has a large enclosed rear garden within which a sensory garden has been constructed and this contains a range of elements including wind chimes, mirrored mobiles, a bird table with hanging feeders, raised plant beds and a Mediterranean style seating area. Evidence was seen from: minutes of relatives meetings, staff spoken to and information, both written and pictorial, displayed in the home of further consultation and planning since the last inspection to develop another section of the garden as a vegetable garden. I was told that people living at the home continue to get a lot of enjoyment from such targeted use of the garden. It was noted however that much of the rest of the garden was overgrown with long grass and weeds. I was also told that this was something that people living in the home were not able to assist with given their needs and preferences and was not a priority for staff given the more direct calls on their time. A good practice recommendation is made that external resources are explored to enable the grass to be regularly cut to provide a more pleasant garden for people to enjoy. At the last inspection a requirement was restated that that the windows in the front ground floor rooms of the home have curtains or blinds fitted. The windows in question are close to the pavement and the interiors of the rooms are clearly visible from the pavement. Given the needs of the people living in the home it is important for blinds or curtains to be fitted to protect their dignity and privacy. This requirement has now been outstanding for nearly twelve months. Evidence was seen of work being progressed to comply with this requirement including a firm quote now having been obtained for the work. However, I was informed that because of the cost of the work from that quote a second quote was now required to comply with the provider organisation’s financial regulations. Work was now underway to obtain the second quote and a senior manager from the provider organisation who visited during the inspection reassured me that this work would now be undertaken as a priority. The requirement is restated again. I was pleased to note that that a requirement made at the last inspection to redecorate and re-equip the sensory room following a water leak from the floor above had been complied with so that people could resume use of that facility. During a tour of the building it was noted that the building generally met the needs of the people living there. I was pleased to see that some new furniture had been purchased for some people’s bedrooms including replacing some beds and carpets. During the tour of the building it was noted that there is a need for additional dining room chairs and tables to be obtained to maximise dining arrangements and dining options for people living at the home. People accommodated often need flexibility in seating arrangements at meal times because of their specific needs and to promote a range of enjoyable eating arrangements for them at different times. At the last inspection a requirement was made that the provider organisation develops a cyclical and costed programme for redecoration of all areas of the Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 24 building but this has not been complied with. The building continues to receive very hard wear and tear due to the needs of the people living there. As a result of this a planned redecoration programme is needed, and the resources identified to undertake this work rather than just reactive work being undertaken when an area becomes unacceptable. The requirement is restated to assist people to continue to live in a pleasant environment. The home continues to have satisfactory laundry facilities and infection control procedures, that staff are aware of. The home was appropriately clean and tidy throughout during the inspection. Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 25 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 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. A staff team with a range of qualifications and competencies, in sufficient numbers, support people living in the home. However, more permanent staff are needed to maximise the continuity of care the home provides. The home’s recruitment policy assists in protecting people living in the home. Those people are also supported by staff who have access to appropriate training and formal supervision to assist them further in both meeting the needs of people living in the home and in there own personal development. EVIDENCE: The home continues to make good progress with enabling permanent staff to achieve the national vocational qualification (NVQ) levels 2 & 3 in care. Evidence was obtained from some staff spoken to and from documentation seen, that team leaders have either achieved or are working towards NVQ level 3 in care. Similarly two support workers have achieved NVQ level 2 in care, three are working towards this and two are on the waiting list to start. Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 26 The home continues to operate with one team leader and three support workers on both the early and late shifts. These staff are supplemented by an additional 72 hours agency staff per week to assist people living in the home to undertake programmed activities, including in the community. This is further described in the Lifestyle section of this report. The manager’s hours are in addition to the above hours. I was pleased to note that the night staff had been increased since the last inspection from 1 waking night support staff, 1 sleeping-in support staff and a sleeping in team leader to 2 waking night support staff and a sleeping-in team leader. However, I was concerned to note that the use of agency staff was currently very high. On the first day of the inspection there was an agency team leader in charge of the shift, two agency support workers and one permanent support worker. In addition there were two agency support workers assisting with people’s programmed activities as described in the paragraph above. The manager was on leave that day. The home only uses one approved agency to provide staff in accordance with L.B. Haringey’s policy on agency staff. I was informed that all the staff on duty on the day had worked at the home previously, had received induction from the home, stated that they had received a range of other up to date core training and were able to describe the needs of the people they were supporting. However, the agency staff working on the day stated that they worked on average only between two and four shifts per month. On the second day of the inspection the team leader was an agency staff although had just been deployed at the home on a full time basis to cover a planned absence of a permanent shift leader. One of the three support workers on duty was a permanent member of staff and the other two were agency staff. These two staff members also confirmed that they had received an induction from the home, that they were familiar with the needs of the people living there but also that they only worked a limited number of shifts per month. Two additional agency staff, who confirmed that they knew the needs of the people, were supporting them with their programmed activities. The manager was also on duty. As described in the Lifestyles section of this report, the home hopes to be able to recruit on a permanent basis to the 72 hours support worker posts that assist with people’s programmed activities. Other agency staff are covering posts where the permanent post holder is unavoidably absent for a set period of time. I was also told that other vacant posts in the home were currently being advertised but that there had been a delay in the recruitment process due to restructuring in Haringey’s learning disability residential services overall. Given the high amount of agency staff currently being deployed and the complex needs of people accommodated a requirement is made that the home recruits and appoints permanent staff to vacant posts to maximise continuity of care for people living at the home. The home holds weekly staff meetings and records of these were seen. Feedback received from staff on staff morale was variable. Some staff spoken to felt that morale was good although others felt that it could improve. A senior manager from the provider organisation who visited during the Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 27 inspection indicated that the organisation was aware of and was addressing some issues that may have a bearing on staff morale in the home. At the last inspection documentation was sampled to evidence that the home operates a satisfactory recruitment procedure to maximise protection for people living at the home. No new permanent staff have been recruited since that inspection. One team leader has a designated role of coordinating staff training needs. This team leader showed me the home’s training matrix that showed evidence that permanent staff are up to date with training and refresher training in core subjects including: safeguarding adults (adult protection), first aid, health and safety, moving and handling, safe administration of medication and food hygiene. A 2-day communication skills course had been run for staff in June 2007 with a further 2 day advanced communication skills course planned for July 2007. I spoke to a support worker who told me that they had attended a Makaton course and the 2-day communication skills course in June 2007 and had found both courses helpful given the communication needs of people living in the home. Evidence was seen that staff receive regular supervision and staff spoken to confirmed this. The manager stated that annual appraisals were now due for staff and that dates had been set for these. Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 28 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 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from it being generally well managed although further improvements in identified areas are still needed to enhance this. The home’s quality assurance systems contribute to the well being of people living there. Health and safety procedures assist in protecting people living at the home, staff and visitors although some further work is needed in identified areas to maximise this protection. EVIDENCE: 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 manager was also very knowledgeable about the needs of the people living at the home. The 15 hours per week administrator is now physically based in the home, which the manager stated was helpful. At the Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 29 last inspection a requirement was made that the registered provider ensures that an application for registration is made to the Commission in respect of the manager, this had still to be complied with. It is important that the manager is registered with the Commission to comply with legislation and to formally verify to the Commission that she is qualified, competent and experienced to run the home. The requirement is restated. At the last inspection a requirement was also made that the registered provider must ensure that an effective on call system is put in place so that the manager does not have to be on call at all times when off duty. The senior manager who visited the home during the inspection stated that an on call option had been discussed but was unable to be pursued. She went on to say that alternative options were being considered and that workable arrangements would be put in place soon. The requirement is restated. The management structure within the home currently consists of a manager and four team leaders. Although team leaders have designated areas of responsibility including for managing the shift when they are on duty there is no one person delegated to deputise for the manager in her absence. The home continues to accommodate people with a range of high needs, including communication needs, and managing the home is a complex and demanding task. A good practice recommendation is made that the management structure of the home be reviewed and consideration be given to creating a deputy manager post. This is to assist the manager with the range of necessary management tasks and to assume delegated responsibility for the home when the manager is on leave. The home operates a key worker system and this is used as a mechanism for ascertaining the likes and dislikes of people living at the home to inform the care and support they are offered. The home also holds monthly meetings for relatives to consult with them and minutes of these meetings were seen. The home has annual aims and objectives that relate and contribute to L.B. Haringey’s overall objectives. On the afternoon of the second day of the inspection the manager was due to hold an annual general meeting with staff at the home to review the home’s achievements to date and discuss how to progress the home’s current objectives. At the last inspection a requirement was made that the home must ensure a copy of a current gas safety certificate is available for inspection. This had been complied with and the certificate seen at this inspection. A current electrical installation certificate was also seen but evidence that the portable appliances had been tested in the past twelve months was not available. A requirement is made regarding this to assist keep people safe. There was also no evidence to document that the home’s water supply had been tested to minimise the risk of legionella in the past twelve months. A requirement is made regarding this to assist keep people safe. The home’s fire log showed that the fire extinguishers had been serviced in the past twelve months, that Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 30 emergency lighting and the fire alarm system are regularly checked and that the home holds regular fire drills. A good practice recommendation was made at the last inspection that the home should check that its current fire plan and fire risk assessment complies with new the fire regulations. The manager stated that this had been acted on and the L.B. Haringey’s own fire prevention officer had visited the home on 19.6.07 and looked at the documentation, she went on to say that she was still waiting on the report from this visit. A good practice recommendation was also made that 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 manager stated that advice had been sought regarding this through the L.B. Haringey fire prevention officer. Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 31 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 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 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.V333282.R01.S.doc Version 5.2 Page 32 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 YA17 Regulation 23(2) Requirement Timescale for action 30/09/07 2. YA20 13(2) 3. YA24 23(2) 4. YA24 23(2) The registered provider must ensure that the kitchen is deep cleaned, as it is a potential health and safety hazard (previous timescale of 31/03/07 not met). The registered provider must 13/08/07 ensure that medication dispensed through a monitored dosage system is dispensed in the appropriate day order to contribute to a robust audit trail regarding the correct administration of the medication. The registered provider must 30/09/07 ensure that the windows in the front ground floor rooms of the home have curtains or blinds fitted to ensure that the privacy of people living in the home is protected (previous timescales of 31/07/06 & 30/04/07 not met). The registered provider must 30/09/07 ensure that additional dining room chairs and tables are provided to allow flexibility in seating arrangements at meal times because of people’s specific needs and to promote a range of enjoyable eating DS0000033209.V333282.R01.S.doc Version 5.2 Linden House Page 33 5. YA24 23(2) 6. YA33 18(1) 7. YA37 8 10. YA37 10(1) 11. YA42 13(4) 12. YA42 13(4) arrangements for them at different times. The registered provider must develop a cyclical and costed programme for redecoration of all areas of the building to assist people to continue to live in a pleasant environment (previous timescale of 28/02/07 not met). The registered provider must ensure that the home recruits and appoints permanent staff to vacant posts to maximise continuity of care for people living at the home. The registered provider must ensure that an application for registration is made to the Commission in respect of the home’s manager to comply with legislation and to verify to the Commission that she is qualified, competent and experienced to run the home (previous timescale of 28/02/07 not met). 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 (previous timescale of 28/02/07 not met). The registered provider must ensure that the home’s portable appliances are checked annually by a person competent to do so, to contribute to the health and safety of all in the home. The registered provider must ensure that the home’s water storage system is checked annually by a person competent to do so, to contribute to the health and safety of all in the home. 31/08/07 30/09/07 31/08/07 31/08/07 31/08/07 31/08/07 Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 34 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 YA6 Good Practice Recommendations The home should where appropriate, cross-reference additional staff guidelines with people’s care plans. This is to ensure that staff, particularly agency staff, are aware of both documents. The provider organisation should continue to seek an independent advocate for an identified person. The home should consult with the G.P. of an identified person regarding the system of administering medication to them to see if it could be administered in a different way to minimise any risk of the medication not being properly swallowed by that person. The home should explore external resources to enable the grass to be regularly cut to provide a more pleasant garden for people to enjoy. The registered provider should review the management structure of the home and give consideration to creating a deputy manager post. This could assist the manager with the range of necessary management tasks and to assume delegated responsibility for the home when the manager is on leave. 2. 3 YA7 YA20 4 5 YA24 YA37 Linden House DS0000033209.V333282.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Harrow Area Office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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.V333282.R01.S.doc Version 5.2 Page 36 - 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. 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