Inspection on 10/07/07 for Linden House Residential Home

This inspection was carried out on 10th 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 but made no statutory requirements on the home.

Other inspections for this house

Linden House Residential Home 21/02/07

Linden House Residential Home 19/06/06

Linden House Residential Home 29/09/05

Linden House Residential Home 31/05/05

Linden House Residential Home 02/11/04

Linden House Residential Home 18/05/04

Similar services:

Dystlegh Grange

Thornton Lodge

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

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

CARE HOMES FOR OLDER PEOPLE Linden House Residential Home Delph Lane Blackburn Lancashire BB1 2BE Lead Inspector Mrs Janet Proctor Unannounced Inspection 10th July 2007 9:30 X10015.doc Version 1.40 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 Residential Home DS0000022493.V339558.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 Older People. 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 Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Linden House Residential Home Address Delph Lane Blackburn Lancashire BB1 2BE 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) 01254 690669 Mr Keshav Savdas Khistria Mrs Kirti Khistria Care Home 40 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (27), of places Physical disability (1) Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for the following categories: Older people over the age of 65 years - OP = 27 either sex Dementia over the age of 65 years - DE(E) = 12 either sex Physical Disability under the age of 65 years PD - 1male 21st February 2007 Date of last inspection Brief Description of the Service: Linden House is a care home that is currently registered to provide personal care for 12 older people with dementia, 27 older people and one person under 65 years of age. The home is owned by Mr K S Khristia & Mrs K Khristia, and they have been the registered persons in respect of Linden House since March 2002. A new Manager has been appointed and is responsible for the day-to-day management of the home. The home is located in a residential area of Blackburn and is close to local amenities of shops, public house, Church, School and Pharmacy. The home is close to a main road and a main bus route. The home is a converted and extended single storey property set in its own grounds. The grounds include a small garden area to the front and side of the home and a small car park. The accommodation for service users has been divided into two separate units, one for those residents with dementia and one for older people. Each unit has a lounge and dining area. There is a mixture of 24 single and eight shared bedrooms. Six of the single bedrooms have en-suite toilet facilities. A Statement of Purpose and a Service User’s Guide were available to give people information about the home. At the time of the inspection the fees for care were £321-00 to £325-00. Extra charges were made for hairdressing, newspapers and personal toiletries and clothing. Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Linden House on the 10th and 11th July 2007. No additional visits had been made since the previous inspection. On the day of the inspection there were 25 residents at the home. Prior to the visit the Registered Person had submitted information in a preinspection questionnaire. This gave information that was used in the planning of the inspection. Surveys were sent out to residents, relatives and professionals involved in the home. Only one survey form was returned and this was by a relative. On the day of the inspection information was obtained from staff records, care records, and policies and procedures. Information was also got from talking to residents, the Manager, staff members and visitors. A tour of the building took place. Wherever possible the views of residents were obtained about their life at the home and their comments are included in the report. What the service does well: What has improved since the last inspection? There was an up to date Statement of Purpose and Service User’s Guide available. This meant that prospective residents had the information they needed to make a decision about whether they would like to live at Linden House. Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 6 The information gathered on the assessment before admission was more detailed. The manager then had all the information she needed to make a decision about whether the home could meet the needs of the resident or not. The activities on offer had improved so that social and recreational needs were met. A resident said, “There’s something going on most days. For example, bingo or a film show, and it’s better than it was. I do reminiscence, drawing and bingo”. A small screen had been built in the lounge and the furniture re-arranged so that it was more homely. Residents said, “I like the room set out like this, it’s much more homely” and “I prefer the lounge like this. I’m still sat in the same place as I’ve always sat but it’s much more cosier now.” Some bedrooms had been decorated and new flooring and new matching bedroom furniture provided. Residents said, “It’s a nice room, I’m very lucky” and “I have a room to my self. It’s very nice and comfortable.” The premises were a lot cleaner. A relative said, “Her bedroom’s lovely and clean, spotlessly clean.” There was liquid soap, paper hand towels and plastic gloves available in the laundry so that staff were protected from infection. All chemicals were clearly named and stored securely. This protected residents and ensured that relevant first aid could be given if needed. What they could do better: The Statement of Purpose should be written in a style that makes it easy for members of the public who may be interested in the home to understand. All residents should receive a copy of their terms and conditions of residency at the time they move into the home. This is so that there is no potential for misunderstandings to occur about what will be provided. Residents coming for respite care must have an assessment before they come to live at the home so that their needs are known and arrangements can be made for these to be met. Prospective residents should receive confirmation in writing that their needs can be met at the home so that they can be confident that they will get the right care. The plan of care for each resident must tell staff precisely how they should meet their needs. The plan should be written with the help of the resident if possible and then kept under review. This is so that the information in it is current and accurate. Health care assessments must be completed as soon as a resident is admitted so that any risks are known and acted upon. The information for staff about the control of medications did not explain properly what they had to do. This meant that mistakes might be made. Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 7 Notices relating to resident’s care should not be on display so that their privacy and dignity is respected. Toiletries should not be left in bathrooms, this is to prevent them being used communally. More care should be taken in ensuring that the personal clothes of residents are returned to the correct room so that they are not used for others. There should be records of the activities done with each resident so that it can be shown that their social and recreational needs are being met. There should be details in the care plan of the preferred daily routine for each resident so that it can be shown that that decisions made about their daily life are in their best interests. Records to show that practices in the kitchen are safe and hygienic should be kept and be available for inspection. There should be a copy of the complaints procedure on display in the home for others to read and know what to do if dissatisfied. All staff employed at the home must receive training in Safeguarding Adults so they know what to do if they see, hear or suspect that something is not right. There were still some areas of the home where the standard of décor and facilities required attention. Until these are done the home does not provide a fully safe, pleasant, comfortable and homely environment for all residents. All required documents and details must be obtained before any new employee starts work so that it can be shown that they are suitable for the post. All new staff must receive a structured Induction training so that it can be shown that they have the basic skills and knowledge to do their work. A record should be made of all training given to staff so that it can be seen which staff have undertaken what training and when. A system for reviewing and improving the quality of care should be established and maintained so that issues requiring attention are identified and can be acted upon in a timely manner. This should include resident and relative meetings and surveys so that they can give their opinion on the home. There must be a separate bank account for residents’ money. This is so that there are clear records of their money and that this is protected from being used for other purposes. All residents who have their benefits managed by a member of staff of the home should receive their full weekly personal allowance. There must be a record of all accidents and injuries to residents so that there is an explanation of where any bruising or marks have come from. Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 8 The records of fire drills should show whether the staff had responded appropriately to the alarm or not so that it can be seen whether they fully understood the procedure. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was sufficient information to enable people to make a decision about the home. Contracts were not issued at the point of moving into the home, which had the potential for misunderstandings to occur. Residents received an assessment so that their needs were known before they came to live at the home. EVIDENCE: The Statement of Purpose had been updated and now contained correct information about the home. This was not in ‘plain English’ and contained words and phrases that might make it difficult for a member of the general public to understand. Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 11 The Service User’s Guide was written in a more easily accessible style. There was some good information and a A-Z with some useful information. It did not state that there was a charge for transport. Contracts were seen for two of the residents whose records were examined. The contract stated the room number, the amount of fees and who these were paid by. There was no contract for a resident who had lived at the home for nearly 3 weeks and for a resident on respite care. The general manager said that contracts were usually issued after first month of residency. All care home providers must give people personalised information about the fees and terms and conditions of their stay, to include accommodation, food and personal care. The information must include the method of payment of the fees and the person or persons by whom the fees are payable. This information should be provided, ideally earlier, but at the latest by the day the person moves into the care home. Two of the residents who had been admitted recently had received an assessment of their needs before moving into the home. The pre-admission assessment done was more in depth and gathered better information. This meant that a proper decision could be made about whether the resident’s needs could be met at the home. There was no record to show that a resident on respite care had been assessed before coming to stay at the home. Prospective residents did not receive a letter telling them whether their needs could be met at the home. This meant they could not be confident that they would receive the right care. Intermediate care was not given at Linden House. Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents had a plan of care, but there was not enough detail to ensure that their health, personal and social care needs were known to staff and could be met by them. Medication practices protected residents’ health. Privacy and dignity was respected. EVIDENCE: The records for four residents were examined. One of these residents had been at the home for over two weeks but did not have a plan of care. No health assessments had been done. This was significant as the pre-admission assessment information said that he had a high risk of falls and he had also had five falls since living at the home. There was no plan of care or health assessments for a resident on respite. There were no photographs to assist staff in correctly identifying these residents. Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 13 The other two residents had a plan of care. One of these showed that there had been consultation with a relative. The information that was in the plans of care was not in enough detail to enable staff to know precisely what to do for the resident. This meant that their diverse needs may not be known and acted upon. For example, there was no information on how to deal with aggressive behaviour from one resident or the dis-inhibited behaviour of another. The care plans had been reviewed every month until May. The review did not give an indication of whether the care that was being given to the resident was achieving the proposed aims. There were records to show that GPs, District Nurses, chirpodists and opticians were consulted as needed. The survey form returned said that staff did not keep them informed of changes, but the relatives spoken to at the time of the inspection said that the staff were good at keeping them informed of any changes in the health of the resident. Medication was stored securely in a locked room. There were records of the date and amount of medications ordered and when the prescription had been seen by the home. When the monthly order of medications were received these were recorded on the Medication Administration Recording chart. Correct codes were used to show why any medication had been omitted. There was no excess stock and there were records of medications returned to the Pharmacy. Eye drops were dated on opening. The Room was still cluttered and there was little space to work in. The policies and procedures were in the process of being updated but those currently available for staff were not explicit enough for them to know exactly what to do. Medications received mid-month were handwritten on the chart. Not all of these were signed and witnessed, did not always record how many had been received or the strength of the medication. This meant that there was the potential for error to occur. Not everyone on ‘as required’ medication had criteria for when these should be given, so these may not be given in a consistent manner. If residents no longer need medication on a regular basis the GP should be asked to amend this to ‘as required’ so that they do not receive this unnecessarily. There was an unidentified tablet seen in a medicine pot in the trolley for the residential unit. Screening was available in all double bedrooms so that privacy was maintained when care was given. A resident spoken to confirmed that the District Nurse gave her insulin injection in her bedroom. There was a notice available for all to read on the senior carers notice board. This gave information about who had a bath on which days, which was undignified for residents. A relative spoken to said that there were still some problems with residents not wearing their own clothes or toiletries being used for others. Toiletries were seen in the bathrooms, giving the impression that they were used communally. Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The increase in activities meant that social and recreational needs were being better met. The daily routines meant that a number of residents had limited choice and control over their lives. Residents received a balanced diet that was to their liking. EVIDENCE: A range of activities were available to be done each week. The manager made the decision each day about what activities would be done and these were generally happened in the afternoon. Residents spoken to said that there was more choice now in the activities offered to them. The record sheets for the activities done had not been completed for some time, which meant that it could not be seen what residents had actually been involved in. Arrangements were made so that the religious needs of residents could be met. Services were held at the home so residents could attend it they wished to. On the day of the inspection there was a big screen film being shown. As this was in the lounge area other residents who were not interested in seeing the Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 15 film had the TV on and the level of sounds from each area appeared to be in competition with each other. A member of staff was seen to be playing a game on a 1:1 basis with a resident. Visitors were welcome at any time and were offered refreshments. Several visitors were seen to come to the home on the day of inspection. A visitor spoken to said that the staff made them welcome when they arrived and were easy to talk to. It was evident that some residents were able to make their wishes and feelings known and to exercise choice about what happened in their daily life. For other residents the decision about what happened to them in their daily routines was made by staff. There was still not much information in care plans about people’s preferred routines. The lack of this information meant that it could not be determined whether routines were staff led or done in the best interests of the residents. There was a choice of hot and cold items at each mealtime. The kitchen assistant was observed to go round and ask each resident what they would like for both lunch and tea. This information was kept as a record to show what diet had been taken by each person. The menu on display was not the current day’s meals, which meant that there was the potential for residents to become confused about what they might be served. Drinks were given mid morning and mid afternoon and residents could request these at any time. A resident was observed to have jug of water on the side table by her chair. She said that this was because she had a dry mouth. The tables were nicely set and residents were offered assistance where needed. A carer was observed to be sitting at the dining table feeding two people at the same time, which is undignified for residents involved. There was fresh fruit and vegetables and sufficient amounts of dried goods. Some records were kept but not all of these were available or up to date. This meant that it could not be shown that the kitchen was maintaining correct hygiene standards. Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents had information about how to complain and were confident that these would be taken seriously and acted upon. Not all staff had received training to ensure that residents were protected from abuse. EVIDENCE: Copies of the complaints procedure was seen in some bedrooms. This did not have the current address of the Commission which may cause misunderstandings about how to contact us. The General manager said that the procedure was being updated and would be reissued to all residents. There was no procedure on display in the home for others to read and know what to do if dissatisfied. There was a record book for complaints. No complaints had been made to the home or to the Commission since the previous inspection. There was conflicting views from people on how issues were dealt with. Residents spoken to said that they’d no complaints. One relative said, “If I had a complaint I would go to the staff. I’ve never had any problems everything’s always been all right” but another said, “I’ve been in the office and told them about things but nothing seems to change.” There was a prevention of abuse policy and a whistle-blowing policy. The procedure for safeguarding adults was not fully specific about what to do and Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 17 the telephone numbers of who to contact if any incident occurred. This is especially important if there is a senior on duty who may never have dealt with anything like this before. Training for all staff in safeguarding adults had not yet been done. Staff spoken to described the correct actions to take. Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were a number of areas that still required attention in order for the home to be a fully pleasant and comfortable place for residents to live. EVIDENCE: The schedule of work was continuing and obvious efforts had been made to improve the environment. These included building a small screen and rearrangement of the furniture in the lounge so that it was more homely. Some bedrooms had been decorated and new flooring and new matching bedroom furniture provided. The premises were also a lot cleaner. The courtyards were cleared and could be used by residents if they wished. Residents spoken to said that they liked the new arrangement of furniture in the lounge and liked their bedrooms. Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 19 There were still some areas of the home where the standard of décor and facilities required attention. Some carpets and flooring were ‘lifting’, resulting in the risk of falls. Redecoration was needed to some bedrooms and nearly all of the corridors, Although the leakage of water had stopped redecoration of the walls after water damage still needed to be done. Some windows were ‘fogged’ up and restricted the view from these. A door to a bedroom did not shut properly causing a risk of there should be a fire. There was a badly stained chair in the lounge of the dementia unit. The laundry was a separate room. It had two washers, one with a sluice programme, and two dryers. There was a sink and liquid soap, paper hand towels and gloves available for dealing with soiled items. There was a sluice on each unit that were kept locked. Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were sufficient staff on duty to meet residents’ needs. Recruitment procedures needed to be more thorough so that they protected residents. Not all new staff had been provided with sufficient training to ensure they could competently undertake activities expected of them. EVIDENCE: There was a rota that gave the name and hours worked of each member of staff. The numbers of carers on duty in the afternoon period had reduced in line with the number of residents and this would be increased when numbers rose again. There were sufficient care and ancillary staff on duty during the 24 hour period. There was an on- call rota so that a member of the management team was always available for advice. The file for three new members of staff an one volunteer were examined. Two of these staff had been recruited through an Agency, and there was no application form. This meant that there was not a full employment history. One file had two pre-issued references and one had one such reference. Because of the lack of employment history it could not be seen whether these were last employers or not. There was also no start date. These two files had evidence Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 21 of valid work permits, a POVA First, a CRB, a health declaration, and proof of identity. The other staff file had an application form with full employment history and reasons for leaving, a POVA First, a CRB, evidence of identity, two references; and a health statement. There was no start date or photo The file for the volunteer had evidence that a CRB check had been done but there were no references of other documents. Two of the new members of staff had not completed the Induction programme. This meant that it could not be shown that they had the basic skills and knowledge to do their work. Staff did not have a separate training file and this made it difficult to determine exactly who had done what training and when. From figures available it as evident that the majority of staff had received training in mandatory subjects, apart from safeguarding adults. 57 of the carers had the National Vocational Qualification level 2 and another 6 staff were on the course. Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The internal auditing systems did not show that the home was run in the best interests of residents. Health, safety and welfare of residents and staff had improved due to the training being given. EVIDENCE: A new manager had commenced employment in June 2007. She has 15 years experience in care work and has the National Vocational Qualification in care level 4. She had a job description and definite lines of accountability. She was aware of the need to submit an application for registration for Linden House. Part of her role was ‘hands on care’ and she had two days supernumerary for management purposes. Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 23 A Quality Assurance system that looked at all of the National Minimum Standards was being developed but was not yet in place. Resident and relatives surveys and meetings would form part of this process. The targets for the last development plan were still being worked towards. A staff meeting not been held for some time and the next one was due at the end of the month. The policies and procedures were being updated and being made more individual to Linden House but were not yet in use. One resident had her finances managed by the home since October 2006. There were no records to show that her weekly personal allowances had been paid to her. A commitment was given that she will be reimbursed these. One of these residents was receiving a lower personal allowance than he should do. There was no separate bank account for residents’ monies. This meant that some inappropriate sums of money were being held on the premises. There were records to show that the safety of the building was monitored. All appliances were serviced as required. Most of the staff had received training in safe working practices. The records of fire drills did not show whether the staff had responded appropriately to the alarm or not. Accident records were kept but were not always completed for each incident. For example, the handover book gave information that a resident had been found on the crash mat and later her right leg around her knee was bruised. There was no accident record for this and nothing was in the daily notes. Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 2 X 2 2 Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 25 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 OP3 Regulation 14 Requirement Each resident must have an assessment before they come to live at the home so that their needs are known and arrangements can be made for these to be met. Each resident must have a written plan as to how their needs in respect of their health and welfare so that staff know how to meet their needs. (Time scale of 30/11/05 not met. This was an extended time frame from previous inspections) Risk assessments for health related issues must be undertaken for all residents and kept under review so that potential problems are identified and can be acted upon. (Previous timescale of 31/05/07 not met.) Routines in the home must be established in the best interests of residents and not staff. (Previous timescale of 31/07/06 not met) All staff employed at the home must receive training in DS0000022493.V339558.R01.S.doc Timescale for action 10/08/07 2 OP7 15(1) 31/08/07 3 OP8 13(4)(c) 31/08/07 4 OP14 12(2)(3) 31/08/07 5 OP18 13(6) 30/09/07 Linden House Residential Home Version 5.2 Page 26 6 OP19 7 OP29 8 OP30 9 OP35 10 OP37 Safeguarding Adults so they know what to do if anything happens.(Previous timescale of 30/09/06 not met) 23(2)(b) The schedule of work must be & (d) continued to ensure that the whole environment is kept suitable for purpose. (Previous timescale of30/06/07 not met) 19Schedul All required documents and e 2(6) details must be obtained before any new employee starts work so that it can be shown that they are suitable for the post. (Previous timescale of 22/02/07 not met) 18(c)(i) All new staff must receive a structured Induction training so that it can be shown that they have the basic skills and knowledge to do their work. 20 Residents’ monies must not be paid into an account that is used by the registered person in connection with the carrying on or management of the care home. This is so that they are protected. (Previous timescale of 31/03/07 not met) 37 There must be a record of all Schedule accidents and injuries to 3 residents so that there is an explanation of where any bruising or marks have come from. 30/09/07 31/07/07 31/07/07 10/08/07 31/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 27 1 2 OP1 OP2 3 4 OP3 OP7 5 6 OP7 OP9 The Statement of Purpose should be written in a style that makes it easy for members of the public who may be interested in the home to understand. All residents should receive a copy of their terms and conditions of residency at the time they move into the home so that there is no potential for misunderstandings to occur about what will be provided. Prospective residents should receive confirmation in writing that their needs can be met at the home so that they can be confident that they will get the right care. Wherever practicable the resident or their representative should be consulted about the plan of care so that they are aware of how they will be cared for and can voice an opinion on this. The review of the residents’ care plans should state an indication of whether the care being given is effective or not. The policies and procedures for the control of medications should be precise in the directions they give to staff so that they know what to do in any situation. Criteria for the administration of when required and variable dose medication should be clearly defined so that they are used consistently A second member of staff should witness all hand written annotations on Medication Administration Record charts to reduce the risk of errors being made Notices relating to resident’s care should not be on display so that their privacy and dignity is respected. Each resident should have their own toiletries. These should not be left in bathrooms to prevent them being used communally. More care should be taken in ensuring that the personal clothes of residents are returned to the correct room so that they are not used for others. There should be records of the activities done with each resident so that it can be shown that their social and recreational needs are being met. There should be details in the care plan of the preferred daily routine for each resident so that it can be shown that that decisions made about the daily life of residents are in their best interests. Records to show that practices in the kitchen are safe and hygienic should be kept and be available for inspection. DS0000022493.V339558.R01.S.doc Version 5.2 Page 28 7 OP10 8 9 OP12 OP14 10 OP15 Linden House Residential Home 11 12 13 OP16 OP29 OP30 14 15 OP31 OP33 16 17 OP35 OP38 Staff should feed residents on a 1:1 basis so that this is done in a dignified manner. There should be a copy of the complaints procedure on display in the home for others to read and know what to do if dissatisfied. The details kept on file for volunteers should include all that as for regular staff. A record should be made of all training given to staff. A training matrix should be used so that there is an easy method of determining which staff have undertaken what training and when. An application for registration for the new manager should be received by the Commission. A system for reviewing and improving the quality of care should be established and maintained so that issues requiring attention are identified and can be acted upon in a timely manner. All residents who have their benefits managed by a member of staff of the home should receive their full weekly personal allowance. The records of fire drills should show whether the staff had responded appropriately to the alarm or not so that it can be seen whether they fully understood the procedure. Linden House Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Residential Home DS0000022493.V339558.R01.S.doc Version 5.2 Page 30 - 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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