Inspection on 19/06/06 for Linden House Residential Home

This inspection was carried out on 19th June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Linden House Residential Home 10/07/07

Linden House Residential Home 21/02/07

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 19th June 2006 08:00 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.V288270.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.V288270.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 Denise Lilley Care Home 40 Category(ies) of Dementia - over 65 years of age (19), Old age, registration, with number not falling within any other category (20), of places Physical disability (1) Linden House Residential Home DS0000022493.V288270.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 29th September 2005 Date of last inspection Brief Description of the Service: Linden House is a care home that is currently registered to provide personal care for 19 older people with dementia, 20 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 Registered Manager 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 was available although these were not accurate. At the time of the inspection the fees for care were £321-00 to £375-00. Extra charges were made for hairdressing, newspapers and personal toiletries and clothing. Linden House Residential Home DS0000022493.V288270.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over two days on the 19th and 20th June 2006. There were two Inspectors present on the inspection. A short visit was made on 3rd July 2006 to obtain information from the Manager, who was on annual leave when the inspection was done. The previous inspection was done on 29th September 2005 and information on the findings of this can be obtained from the home or from www. CSCI.org.uk. No additional visits had been made since the previous inspection. Two concerns had been raised by relatives and the issues of these were looked at during the inspection process. The issues included: behaviour of residents; cleanliness; food; mobility; pads; healthcare; mode of dress; and staff attitude. On the day of the inspection there were 29 residents at the home. Information was obtained from staff records, care records, and policies and procedures. Information was also got from talking to service users, members of staff, a District Nurse and the Manager. Four comment cards were received from residents. Wherever possible the views of residents were obtained about their life at the home and their comments are quoted in the report. What the service does well: All of the surveys returned to the Commission said that the residents always liked the meals. Residents spoken to said, “The food’s good here, we get some good lunches. They come round with a card and ask you what you want” and “The food’s very nice – plenty of it. Sometimes too much.” Some residents felt that they could make choices about what happened in their lives. These were residents who were capable of making decisions about their lives and were able to ‘speak out’. They said, “I still get up early but I’m all right about it. They come and give me help. I go to bed at about 8.30 pm”, “I generally get up about 8.00 am” and “I choose what time to get up. If you’re feeling a bit tired you can stop in bed. I choose what time to go to bed.” Visitors were welcome at the home at any time. One visitor was there at 8.00 in the morning on one of the days of the inspection. Some visitors came every day. One resident said, “I get plenty of visitors – they can come anytime and my son brings his dog.” Two of the survey forms returned said that they knew who to speak to if they were unhappy and knew how to make a complaint. A resident said, “I’ve never really had to make a complaint. I would speak to the Manager”. The residents who returned survey forms all felt that the staff listened to what they had to Linden House Residential Home DS0000022493.V288270.R01.S.doc Version 5.2 Page 6 say. Residents spoken to were happy with the care they received from the staff. They said, “The girls are lovely. They are all looking after me very well” and “The staff are very nice, there’s nothing to grumble about at all.” What has improved since the last inspection? What they could do better: There must be an up to date Statement of Purpose and Service User’s Guide available. This is so that prospective residents have the information they need to make a decision about whether they would like to live at Linden House. Once admitted to Linden House residents must receive a contract or terms and conditions of residency. This is so that they have information on what will be provided for the money they pay. After having an assessment of their needs prospective residents must receive confirmation in writing that the home can meet these needs. This is so that they can be confident that the home has the right accommodation, staffing and equipment. The plan of care for each resident must tell staff precisely how they should meet their needs. The plan should be written with the input of the resident if possible and then kept under review. This is so that the information in it is current and accurate. Medication practices were not thorough enough to ensure that the health of residents was safeguarded. The records kept must be accurate. The amount of stock held must be reduced and the medication kept must be in date. Staff must ensure that they always protect the privacy and dignity of residents. Labels must not be on show where people other than the care staff can read them, privacy screening must be used in all double rooms and residents’ personal toiletries must not be used for others. Linden House Residential Home DS0000022493.V288270.R01.S.doc Version 5.2 Page 7 Staff were getting some residents up early in the morning without an indication that this is what they wanted to do and to fit in with staff routines. The lack of written information on care plans meant that staff did not know enough about residents’ likes, dislikes and preferences. There were not enough suitable activities organised for residents who were not able to occupy themselves. One resident said, “I’m just sitting all day. We have Bingo for 10 minutes only, there’s nothing whatsoever going on” and “There’s not very much going on – a sing-a-long sometimes and bingo but not very often. The staff are too busy.” The staff numbers reduced in the afternoon so there was little opportunity for staff to do activities with the residents. Arrangements must be made to ensure that there are enough staff hours for activities to be done with residents. All new staff must receive structured Induction training. Each year all staff must have training that covers all aspects of care, health and safety, protection of vulnerable adults, moving and handling and fire procedures. This is in order to ensure that all staff are competent and to protect residents and staff. The source of leaks and damp must be investigated and necessary repairs made. The overall cleanliness must be improved and any stained furniture and carpets cleaned or renewed. Areas that require redecoration must be done. This needs to be done to make Linden House a clean and comfortable place for residents to live. The recruitment procedures must be thorough and all necessary documents, for example references, must be obtained before anyone starts work. This is so that residents are safeguarded. Staff must receive supervision from an experienced member of staff if they start work without a full Criminal Records Bureau check. They must also be supervised during their induction training. After this they should receive regular supervision 6 times throughout the year. This is in order that their performance is monitored and they can raise queries about aspects of their work. The amount of self-auditing must be extended. This is so that the Manager can identify areas that needed attention and to create an action plan to resolve these. The financial situation of a specific resident should be investigated in conjunction with his Social Worker to ensure that he receives all the benefits due to him. The registered provider has been required to submit an improvement plan to tell us how, and by when, they are going to make the necessary changes to comply with the regulations and improve outcomes for people who are using the service. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Linden House Residential Home DS0000022493.V288270.R01.S.doc Version 5.2 Page 8 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.V288270.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Up to date information was not available about the home. New residents had not been issued with a copy of the contract so they did not know the terms and conditions of residency. Residents could not be confident that the home could meet their needs, as they did not have this confirmed in writing. EVIDENCE: Details in the Statement of Purpose and Service User’s Guide were not accurate, for example the manager’s name. The information did not tell prospective residents that there was a dementia unit at the home. This meant that any prospective resident would not be able to make a fully informed decision about whether they would like to live at Linden House. Residents who had been admitted recently had received an assessment of their needs before moving into the home. The fact that the home could meet these needs had not been given to them in writing. The recently admitted residents did not have a copy of the home’s terms and conditions of residency on file. Linden House Residential Home DS0000022493.V288270.R01.S.doc Version 5.2 Page 10 This has the potential to create misunderstandings about what is to be provided by the home. Intermediate care is not given at Linden House. Linden House Residential Home DS0000022493.V288270.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is poor. 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. Some of the medication practices meant that residents were not safeguarded. The lack of detail in respect of dying and death meant that residents could not be assured that their wishes would be known and carried out. EVIDENCE: Residents had an assessment of their needs before and on admission. Not all of these needs were transferred to the plan of care. 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. For example, there was nothing about confusion and memory loss in the plan of one resident. Another resident had a dressing to her leg but there were direction to carers about this. Another resident had dementia but there were no details at all in his plan of care about this. The assessment for a resident stated that he was blind and there was no mention of this in the plan of care. There was only one care plan seen out of 4 that had evidence of consultation with a relative. Linden House Residential Home DS0000022493.V288270.R01.S.doc Version 5.2 Page 12 The care plans were reviewed every month. The accuracy of these was poor. One resident had been showing aggressive behaviour over a period of 2 months. This was not mentioned in the review and the plan of care had not been changed. This meant that carers had no direction about how to reduce, respond to or manage this. The plan for one resident referred to toileting when he actually had a catheter in place. New needs and problems were not identified. For example a resident had fractured his wrist but this was not mentioned. The need for strong pain control for an illness was not mentioned. More detailed daily records were now being made. Only one plan viewed had any reference to discussion about wishes in respect of death or dying. There were a variety of assessment systems to enable residents’ health care needs to be assessed and identified. These included: the risk of developing pressure sores; nutritional risk; continence needs; risk of falls and moving and handling needs. Continence pads were seen to be stored individually in residents’ bedrooms. There were records to show that GPs were contacted and requested to visit. The District Nurse visited one of the residents whose files were viewed and there was evidence her records were kept in the home. A District Nurse was spoken to and she said that the staff at the home were good at bringing health issues to their attention. There were records to show that residents were referred to the Chiropodist and that she had visited. Observation of care showed that some staff appeared frightened of a specific resident. They approached him very reluctantly and don’t interact with him. On the second day of inspection he was up before 7.40 am. He was not seen to be offered a drink, breakfast or lunch. In the afternoon of that day his toileting chart said that he had refused at 9.00 am. However, he had not been approached by any member of staff from 7.40 am – 9.30 am. One resident was seen to be left sitting in her wheelchair for a lengthy period of time. Observation of care practices showed that a specific resident was not appropriately assisted with taking fluids. His diet was fed to him by staff as he was unable to do this himself but his drinks were not given. The plans of care viewed stated that staff should promote independence, privacy, dignity and choice, but were not specific about how to do this. Staff spoken to were able to describe the actions they would take to protect residents’ privacy and dignity. One resident spoken to said she was treated with respect. One visitor spoken to felt that her friend’s toiletries and clothes were sometimes being used for others. A resident spoken to said how she was wearing a new dress. She said that she bought new clothes about twice a year. There were notices for staff on display on residents’ wardrobes. On the first day of the inspection the District Nurses were seen to move residents to their bedrooms to do treatments but on the second day gave residents insulin injections whilst they were sat at the dining tables and in full view of other residents. There was one double bedroom that did not have privacy screening. Linden House Residential Home DS0000022493.V288270.R01.S.doc Version 5.2 Page 13 Staff had received training on medication management. However, a member of staff was seen to transfer medication from the blister pack using her fingers. The medication storage area was cluttered and untidy with large amounts of medication for return to the Community Pharmacy. Not all of the medications for return had been recorded. Records were kept of medications received. There were 2 dosette boxes of medications in the trolley that were not named. The temperature of the fridge was recorded daily. This had risen too high on 3 occasions but there was no record of any action taken. There were no records of room temperature. The trolley was secured correctly. The recording on the Medication Administration Recording charts was such that there was potential for error. For example, hand written entries were not signed and witnessed. Some of the entries did not accurately repeat the instructions on the medicine container. Medication was not always given as prescribed with no reason for the omission. For those residents who needed as required medication there was no criteria as to when this should be given. For those on a variable doses, there was no criteria for when to give 1 or 2 tablets. There was a record on the chart whether 1 or 2 had been taken. The stock control was poor. There were large amounts of stock for some residents. This was due to over dispensing rather than over ordering. The GTN spray for one resident expired in April 2005. As there was no other spray for her to use should she have an angina attack this had potential severe consequences. There was an appropriate storage facility and a recording book for Controlled Drugs. Those that were recorded in the book were correct. However, there were 14 Temazepam tablets in the cupboard that needed to be returned to the Community Pharmacist and these were not recorded in register. This meant that there was no record of these being in the home. Linden House Residential Home DS0000022493.V288270.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 at least once during a 12 month period. 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. A number of residents had limited choice and control over their lives and many were under stimulated. Residents liked the food served but the lack of accurate records meant that safe storage of food stored could not be guaranteed. EVIDENCE: Some residents were able to pursue their own individual interests. These included knitting and crosswords. Residents’ interests were recorded in the assessment documentation but these were not followed up with a realistic plan of activities. The advertised programme said that activities were done from 1.00 pm – 4.00 pm every weekday and included bingo, puzzles, manicures and films. Bingo was seen to be done straight after lunch for a very short period of time on the days of the inspection. 5 residents were involved. The records of activity done showed that the only activity over the last seven weeks had been 8 sessions of bingo. 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 decided by staff. On the two days of the inspection there were a large number of residents up and dressed by 8.00 am. Not all of these residents were able to Linden House Residential Home DS0000022493.V288270.R01.S.doc Version 5.2 Page 15 say whether they wished to get up or not. The minutes of a staff meeting indicated that night staff must get residents up. From these notes and discussion with night staff it was evident that residents were got up and put to bed in line with staff routines. Visitors were welcome to visit at any time and were offered refreshment. One visitor was seen at the home at 8.00 am. Two visitors were spoken to. They both felt that the staff at the home kept them informed about the health and condition of their relative or friend. There was a 4 week menu. This showed a choice of meals at lunch time and tea. There was a record of the choices made by residents and if anyone had anything different to the menu. The Cook was aware of a resident’s allergy to cheese. There was no indication around the home of what the day’s meal was. This meant that residents were unaware of what they would be served. There was food available for the night staff to prepare snacks. Any pureed diets had their components done separately so that they looked more attractive. Fresh vegetables were delivered every week and there was some fresh fruit. There was a Cook on duty every day and usually a kitchen assistant. The temperature of cooked food was recorded. The fridge and freezer temperatures were recorded. These showed freezers as being minus 5 degrees, and minus 10 degrees and the fridge as being 20 degrees. These temperatures are not the recommended ones for safe storage of food but there was no record of any action to find out why these temperatures were being shown. Linden House Residential Home DS0000022493.V288270.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 inspected at least once during a 12 month period. 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 that these would be taken seriously and acted upon. Not all staff had received training to ensure that residents were protected from abuse. EVIDENCE: There was a copy of the complaints procedure in each bedroom. This told the resident whom they should complaint to and that they would receive a response within 28 days. The address and telephone number of the Commission was also displayed. There was record system for any complaints received by the home. This showed that one complaint had been made direct to the home. The records showed the issue of the complaint, the action taken and the outcome. Since the previous inspection the Commission has received two concerns about Linden House, the issues of which were looked at as part of the unannounced key inspection. The Whistle blowing procedure and some very good guidelines on recognising and responding to abuse were on the carers’ notice board. These were very well written and included very clear ‘dos and don’ts’. The Protection of Vulnerable Adults procedure was not in the policy and procedure file. Since September 2005 16 staff have received training in Protection of Vulnerable Adults. Staff spoken to were aware of what action to take should the suspect or witness abuse. Linden House Residential Home DS0000022493.V288270.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of thorough maintenance and redecoration meant that residents could not be assured of a safe and comfortable home. The entire premises were not clean and hygienic and this detracted from residents’ comfort. EVIDENCE: A handyman was employed for 15 hours per week. He took responsibility for repairs, decorating and keeping the gardens neat and tidy and his allocated hours were not enough for him to do all this. Although some efforts had been made to make improvements to the home the overall standard of accommodation was not as good as it should be. Some bedrooms had been redecorated and a few of these had also had new floor coverings and new curtains. Since the last inspection new carpets had been laid in the lounge and corridors. These were now quite badly stained and a large number of the seams were fraying and lifting causing a potential trip hazard. A number of dining room chairs were also badly stained. Linden House Residential Home DS0000022493.V288270.R01.S.doc Version 5.2 Page 18 Areas of damage on the corridors had been ‘filled’ but not made good and redecoration had not taken place. Items of furniture had not been repaired or had parts missing. For example: an overhead light without a cover; ripped cover to a commode; a missing toilet seat; holes in toilet doors allowing the person using it to be visible to someone outside; broken bedside drawers; broken window restrictors and one window that did not close properly; and a lack of curtains and blinds in one bedroom. There were a number of bedrooms where it was obvious that there was a problem with damp around windows, on walls and some ceilings. There was a leak on the corridor near the office. The overall cleanliness of the home was poor. There were bedrooms where the flooring required cleaning, either mopping or hoovering, and window ledges and other items of furniture were dusty. Items of furniture stained with urine and faeces were seen in a number of bedrooms. Walls in bedrooms were stained with dirty marks. The outside courtyard for the new dementia unit had new garden furniture. The courtyard for the older persons unit was unattractive and its appearance and lack of facilities did not encourage residents to use it. There were 2 clocks in the lounge of the dementia unit. One of these had stopped and was showing an incorrect time. This meant that residents were being further disorientated to time. The laundry was a separate room. It had two washers, both with a sluice programme, and two dryers. There was a sink with liquid soap and gloves were available for dealing with soiled items. There was a sluice on each unit. The door to the sluice on the dementia unit was not locked. A container of cleaner was seen inside room and could potentially be accessed by residents. Linden House Residential Home DS0000022493.V288270.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. 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 during the most of the day. Recruitment procedures were not through and did not protect residents. All staff needed to receive training to ensure residents were safe and their needs were being met. EVIDENCE: There was a duty rota showing which staff were on duty and at what times. There were Senior Carers, carers and ancillary staff in sufficient numbers in the morning and evening. The number of carers reduced in the afternoon period, which meant that there were no staff available to do activities with residents.. During the day time there was currently 1 carer on dementia unit for the two residents accommodated. The duty rota showed some sickness and absence levels and a recent turnover of staff. Two new employees had been recruited since the last inspection. The records of these were examined and showed that thorough procedures had not been followed. One member of staff was due to start her first day employment on the second day of inspection. There were no references available for her or the other employee who had been employed for one month. The deputy said that verbal ones had been taken up but there was no record of this. There was no proof of identity for these staff members. There was an application form that gave a full employment history and the reasons for leaving. A health questionnaire was completed. POVA First had been obtained and a full CRB check awaiting return. Linden House Residential Home DS0000022493.V288270.R01.S.doc Version 5.2 Page 20 The employee who was due to commence her first day of employment was on the rota as working on the dementia unit that evening. Her full CRB had not been returned. As there was only one staff member on duty there, this meant that she would be unsupervised. Induction training for new employees was not thorough. A new member of staff had been showed some essential things about fire safety and other health and safety issues but there was no record of this. Another recent employee had no evidence in her Induction book that she had been shown any care tasks and was competent to do these. Training opportunities were made available to staff and each member of staff had an individual training file. Some staff members had done a lot of training and others had done very little. Further dementia training was needed for all staff as on the day of the inspection there were staff working on the unit without any formal dementia training. There were several handout type info booklets on dementia on staff notice board. These gave very good information, including definitions and signs and symptoms. They also included information on communication, dealing with aggression and the person centred approach. 30 of the carers had NVQ 2 or 3 in care. Other staff were currently enrolled on the course. Linden House Residential Home DS0000022493.V288270.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were confident that the home was well managed. The internal auditing systems did not show that the home was run in the best interests of residents. The lack of safe working practice training for staff meant that the health, safety and welfare of staff and residents was not protected. EVIDENCE: A registered manager took responsibility for the day-to-day management of the home. She had many years of experience of working in a care setting and had the NVQ level 4 qualification. Staff and residents spoken to felt confident in her abilities to manage the home. There were some internal audits done. These were more of a statement of policy than an actual audit of whether things were in place and working well. Linden House Residential Home DS0000022493.V288270.R01.S.doc Version 5.2 Page 22 Residents’ meetings were not held. The manager said that she speaks with residents on an individual basis but there was no record of their opinions of things. Staff meetings were held on a regular basis. From the staff meeting minutes it was apparent that there was a problem with the attitude of some staff. The Manager said that the persons concerned were being dealt with through appropriate channels. She had prepared questionnaires for relatives to complete but only one of these had been returned. The Manager was appointee for two residents. The money for one of these residents had not been paid into the right bank account by the Benefits Agency, meaning that the resident was no getting any personal allowance. The manager was in the process of trying to resolve this. A separate record was kept for each resident who had money saved at the home. The record showed the amounts paid in and out. There was only one signature on the record. The money held for three residents was checked against the record and found to be correct. There was a receipt book for items and money handed over. Supervision was being done for carers every 3 - 6 months. There was a system for recording the discussion. This covered: duties expected; support given; areas of concern; training; individual strengths and weaknesses; grievances, timekeeping; rota and shifts; and a general discussion. Records of annual appraisal were kept in staff files. Not all accidents were recorded correctly and the Commission was not being informed of events that affected the welfare of residents. For example there was no record of a resident falling from her wheelchair. A resident had a fractured wrist. There were three records of aggressive incidents between residents resulting in someone being hurt. No notification had been sent to the Commission about these incidents. There was a work based fire risk assessment. Fire safety equipment had been tested. Weekly tests were done to ensure that the fire alarms and emergency lighting worked correctly. The last fire drill was in May 2006, this included the name of staff and how they responded. Evidence was seen that the electrical installation and Portable Appliance Testing had been done in May 2006. There were records to show servicing of the gas appliances and the moving and handling equipment. Clinical waste was stored and disposed of correctly. Water temperatures for bathrooms recorded monthly. There were some risk assessments for working practices. Training for staff in health and safety and safe working practices had improved. However not all staff had received training in these subjects. Linden House Residential Home DS0000022493.V288270.R01.S.doc Version 5.2 Page 23 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 1 1 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 2 2 2 Linden House Residential Home DS0000022493.V288270.R01.S.doc Version 5.2 Page 24 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 OP1 Regulation 4&5 Requirement There must be an up to date Statement of Purpose and Service User’s Guide available to current and prospective residents All residents must be provided with a contract or statement of terms and conditions Before that are admitted residents must receive confirmation in writing that the home can meet their needs Each resident must have a written plan as to how their needs in respect of their health and welfare are to be met. (Time scale of 30/11/05 not met. This was an extended time frame from previous inspections) The plan of care must be kept under review and all new needs or problems that are identified must be added to the plan of care. Wherever practicable the resident or their representative must be consulted about the plan of care. DS0000022493.V288270.R01.S.doc Timescale for action 31/07/06 2 3 OP2 OP3 5(1)(b-c) 14(1)(d) 31/07/06 21/06/06 4 OP7 15(1) 31/08/06 5 OP7 15(2)(b) 31/08/06 6 OP7 15(1) 31/08/06 Linden House Residential Home Version 5.2 Page 25 7 OP8 12(1)(b) 8 OP9 13(2) 9 OP9 13(2) & 17(1)(a) 10 11 OP9 OP9 13(2) 13(2) 12 13 OP9 OP10 13(2) 12(4)(a) 14 15 OP10 OP12 12(4)(a) 16(2) (m-n) 16 OP14 12(2)(3) Residents must receive the care that they require. This would include being assisted with food, drinks and being taken to the toilet. All medciations must be given in an hygienic manner. They must not be handled when being transferred from the blister pack prior to being adminsitered. Full and accurate records must be kept of all medicines received, administered and leaving the care of the home. There must be a full record of all medication currently prescribed for each resident. (Previous timescale of 03/12/04 not met) All dosette boxes must be clearly marked with the name of the resident. Expiry dates of medication must be checked on a regular basis and if this has expired new medication must be obtained. Medications kept in the Controlled Drug cupboard must be entered into the register. Arrangements must be made to ensure that the privacy and dignity of residents is protected. This must include the removal of notices about residents’ care, treatments being provided in private and privacy screening in bedrooms. The personal clothes and toiletries of residents must not be used for others. Following consultation with residents the current programme of activities must be revised. There must be sufficient appropriate activities to meet the needs of the residents Routines in the home must be established in the best interests of residents and not staff. DS0000022493.V288270.R01.S.doc 21/06/06 21/06/06 31/08/06 21/06/06 21/06/06 21/06/06 31/07/06 21/06/06 31/08/06 31/07/06 Linden House Residential Home Version 5.2 Page 26 17 OP14 12(3) 18 OP15 16(2)(j) 19 20 OP18 OP19 13(6) 13(4)(a) (c) 23(2)(b) 21 OP19 22 OP19 23(2)(b) & (d) 23 24 OP19 OP19 23(2)(b) 23(2)(d) 25 26 OP26 OP29 13(4)(a) 19 Schedule 2 27 OP29 19 Care plans must include details of residents’ preferences, including preferred times of rising and retiring. (Timescale of 25/11/05 not met) Appropriate records relating to the storage of food items must be kept. (Previous timescale of 30/06/05 not met) All staff employed at the home must receive training in Protection of Vulnerable Adults. All parts of the home accessible to residents must be hazard free. All carpets must be firmly fixed and not cause a trip hazard. The cause of damp and water ingress to the home must be identified and action taken to repair this. A schedule of work to show how and when all areas of repair and redecoration are to be completed must be submitted to the Commission. (Previous timescale of 24/07/05 not met) All windows must be able to be properly closed by either staff or residents. All areas of the home must be kept clean. Items of furniture must be appropriately cleaned when stained. All carpets must be deep cleaned. The sluice door on the dementia must be kept locked or all chemicals be removed. Thorough recruitment procedures must be completed before anyone starts work at the home. This must include the taking up of written references and obtaining proof of identity. An experienced member of staff must supervise any new employee working before the full CRB is returned. DS0000022493.V288270.R01.S.doc 31/08/06 31/07/06 30/09/06 31/07/06 31/08/06 31/07/06 31/07/06 31/07/06 21/06/06 21/06/06 21/06/06 Linden House Residential Home Version 5.2 Page 27 28 OP30 18(c)(i) 29 OP33 30 OP33 31 OP33 32 OP37 33 OP38 All new employees must receive structured induction training. A record of the things they are shown must be made and their competency to do these assessed. 24 A system for reviewing and improving the quality of care must be established and maintained. (Time scale of 24/10/05 not met). 12(5)(b) All staff must maintain good personal and professional relationships with residents. Appropriate disciplinary action must be taken for those staff whose attitude is not acceptable. 24A(1)(2) An improvement plan must be (3) sent to the Commission. The plan must tell us how, and by when, the necessary changes will be made to comply with the regulations and improve outcomes for people who are using your service. 37 There must be a record of all Schedule accidents to residents. Any 3 serious injury or event that affects the wellbeing of residents must be notified to the Commission. 2394)(d) All staff must receive training in: & 18(c)(1) fire safety; moving and handling; infection control; basic food hygiene; and first aid. (Time scale of 31/12/05 not met) 21/06/06 30/09/06 21/06/06 16/08/06 21/06/06 30/09/06 Linden House Residential Home DS0000022493.V288270.R01.S.doc Version 5.2 Page 28 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 OP8 Good Practice Recommendations Residents should be assisted with their mobility. This should include being assisted to move from wheelchair to armchair and not being left sitting in one place for any great length of time. Arrangements should be made with the Community pharmacist for the unnneded medication to be returned in a timely manner. There should be a record of the temperature of the drug storage room. A record should also be made of the action taken if the temperature of the room and/or the fridge rises above the recommended maximum. Criteria for the administration of when required and variable dose medication should be clearly defined and recorded for all service users prescribed such items.A second member of staff should witness all hand written annotations on Medication Administration Record charts. Discussion shoulkd take place with the Community Pharmacist about the dispecsing of medicatiosn to ensure that over stocking does not occur. Unneeded medication should be returned in date order. The wishes in respect of dying and death should be recorded. If the resident does not wish to discuss these, a record of this should be in the plan of care. Staff should ensure that decisions they make about the daily life of residents are in the best interests of the resident. This would include rising and retiring times. There should be information available to residents on what the meals will be that day. New thermometers should be obtained to ensure that there is an accurate record of the storage temperature of food. The Protection of Vulnerable Adults procedure should be available in the policy and procedure file. All clocks should show the correct time so that residents do not become disorientated. Staff should be encouraged to undertake the NVQ 2 qualification so that 50 of the staff have this by the end of 2005. DS0000022493.V288270.R01.S.doc Version 5.2 Page 29 2 3 OP9 OP9 4 OP9 5 OP9 6 7 8 9 10 11 12 OP11 OP14 OP15 OP15 OP18 OP19 OP28 Linden House Residential Home 13 OP30 14 15 OP35 OP36 Dates of training undertaken should be put on the training matrix so that there is an easy method of determining whether staff have undertaken 3 days training in each 12 month period. Arrangements should be made to ensure that the benefits for a specific resident are paid into the correct account so that money due to him can be used for his comfort. A programme of supervision dates should be set to ensure that all staff receive this 6 times in each year. Linden House Residential Home DS0000022493.V288270.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Linden House Residential Home DS0000022493.V288270.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!