Inspection on 21/02/07 for Linden House Residential Home

This inspection was carried out on 21st February 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 10/07/07

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 21st February 2007 7:00 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.V326568.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.V326568.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 (12), Old age, registration, with number not falling within any other category (27), of places Physical disability (1) Linden House Residential Home DS0000022493.V326568.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 19th June 2006 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 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 were available although these were not accurate. At the time of the inspection the fees for care were £321-00. Extra charges were made for hairdressing, newspapers and personal toiletries and clothing. Linden House Residential Home DS0000022493.V326568.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 21st February 2007 by two Inspectors. No additional visits had been made since the previous inspection. On the day of the inspection there were 24 residents at the home, 21 requiring care for their needs as older people and 3 requiring care for their dementia needs. Prior to the visit the Registered Manager had submitted information in a preinspection questionnaire. This gave information that was used in the planning of the inspection. Surveys were sent out but none were returned by residents or relatives. 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 a visitor. 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: Nearly all the residents spoken to praised the staff. In particular one resident said, “The staff are nice. They are always polite and not just with me but with everyone. You can’t expect young people to always understand what it’s like to be old. But they seem to do that here – the staff are always patient and polite. They seem to understand.” This indicated that the staff were aware of residents’ needs and took time and trouble to meet these in a sensitive manner. Another resident said, “The staff are lovely. I like the fact that I can have a joke with them and they make me laugh.” Visitors were welcome at the home at any time. Some visitors came every day. A visitor spoken to said that the staff made her feel welcome when she came. They were easy to speak to and she felt she would be able to tell the Manager if anything was not right. Apart from one resident all those spoken to liked the food. They said, “The food’s very good and we get a choice” and “The food’s good and I always enjoy my meals.” 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’. A resident said, “I get up early. They don’t get me up, I get up myself.” Linden House Residential Home DS0000022493.V326568.R01.S.doc Version 5.2 Page 6 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. The information gathered on the assessment before admission should be more detailed. This is so that the manager has all the information she needs to make a decision about whether the home can meet the needs of the resident or not. 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 Linden House Residential Home DS0000022493.V326568.R01.S.doc Version 5.2 Page 7 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. The procedure for medication given in food or drink was not being followed properly. This was a potential risk to residents. 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. Not all staff were seen to talk to residents when they were helping or caring for them. This meant that they were not being given an explanation of what was happening or any social stimulation. 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. There must be liquid soap, paper hand towels and plastic gloves available in the laundry so that staff are protected from infection. There must always be three members of staff on at night. This is so that all the residents receive the care that they need. If the Manager is called into the home this time must be recorded so that there is an accurate record of when she has worked. Any gaps in employment must be explored at interview so there is a record of what the person has been doing in that time. This is to ensure residents are protected. More training on the needs of residents with dementia must be given to those staff who work on that unit. This is so that they have a thorough understanding of the needs of these residents and know how to meet these. 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. There must be records of fees charged and paid available for inspection and 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 should receive their full personal allowance All events that affect the health or wellbeing of a resident must be reported to the Commission. This is so that we are aware of what is happening at the home and can offer advice or do a visit if needed. All chemicals must be clearly named and stored securely. This is so that residents are protected and relevant first aid can be given if needed. Linden House Residential Home DS0000022493.V326568.R01.S.doc Version 5.2 Page 8 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.V326568.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.V326568.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. Up to date information was not available about the home and the details in the contracts were not complete. This could lead to potential misunderstandings about what is provided at the home. Residents received an assessment of their needs and confirmation that these could be met. EVIDENCE: The details in the Statement of Purpose and Service User’s Guide were still not correct. This did not correctly state the number of residents that could be accommodated on the dementia unit. The manager said that they were waiting for a new Statement of Purpose and Service User’s Guide to be printed. She said that she would send a letter with information about the home to any prospective residents or give them a copy if they visited the home. There were two resident still without a contract. The contracts seen were not complete in their details. They did not specify what charges would be made for Linden House Residential Home DS0000022493.V326568.R01.S.doc Version 5.2 Page 11 escorts/taxis, the total fees payable or who pays the fees, or the room number to be occupied. Discussion took place on ensuring that specific agreements for individual residents about charges were always specified in their contract. Residents who had been admitted recently had received an assessment of their needs before moving into the home. The pre-admission assessment done by the home did not gather detailed information about the needs of the resident. This meant that a proper decision might not be made about whether the home is suitable for the resident’s needs. Prospective residents received a letter telling them whether the home could meet their needs or not. Intermediate care was not given at Linden House. Linden House Residential Home DS0000022493.V326568.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 had improved and protected residents’ health. Privacy and dignity was respected. 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. This meant that their diverse needs may not be known and acted upon. For example, a plan for a resident with dementia did not tell staff what they had to do support or manage this. Another resident had some continence and personal hygiene needs and these were not mentioned in the plan of care. These things meant that residents may not get the care they need and in a consistent manner. Linden House Residential Home DS0000022493.V326568.R01.S.doc Version 5.2 Page 13 None of the three care plans seen had evidence of consultation with the resident or relative. The care plans were reviewed every month. The review did not give an indication of whether the care that was being given to the resident was achieving the proposed aims. More detailed daily records were now being made so that there was a report of how the resident had been cared for. 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. These had not all been completed for a recently admitted resident. This was significant as the pre-admission assessment information said that he had a high risk of falls. Continence pads were seen to be stored individually in residents’ bedrooms. There were records to show that GPs were contacted and requested to visit. There were records to show that residents were referred to the Chiropodist and that she had visited. There were now some good practices in respect of medications. There were some very good records about what had been ordered and when. The records also showed that the prescriptions were seen before the medications were dispensed. All medications received and disposed of were accurate and up to date. The amount of stock held had reduced and was being rotated. Fridge temperatures were recorded daily. Controlled Drugs were stored correctly and in a proper register. These were checked against the register and the Medication Administration Recording chart and found to be correct. Some Controlled Drugs removed from the home some time ago had not been signed out of the register. The Room was still cluttered and there was little space to work in. The policies and procedures were not explicit enough for staff to know exactly what to do. A resident was receiving his medication in food or drink with the agreement of his GP. The Covert Medication policy said there must be a risk assessment and a care plan to ensure that the resident receives this safely but this had not been done. There was no criteria for as required medications so these may not be given in a consistent manner. Handwritten entries were not signed and witnessed so there was the potential for error if these had been written incorrectly. There were very few unexplained gaps on the recording charts. There was an unidentified tablet seen in a medicine pot in the trolley for older people and an unidentified tablet in a box in the trolley for residents with dementia. Eye drops were not always dated on opening. Issues relating to privacy and dignity had improved. The daily notes for a resident said “carers waited outside toilet to give some privacy”. Staff that were attending to a resident in a bedroom overlooking the courtyard were seen to close the curtains before delivering care. Privacy screening was available in all double bedrooms. There were still some notices on display in bedrooms. A resident spoken to confirmed that the District Nurse gave her insulin injection Linden House Residential Home DS0000022493.V326568.R01.S.doc Version 5.2 Page 14 in her bedroom. A relative spoken to said that there were sometimes things in the wardrobe that had other residents’ names in. Linden House Residential Home DS0000022493.V326568.R01.S.doc Version 5.2 Page 15 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: Some residents were able to pursue their own individual interests. These included knitting and crosswords. Residents’ interests were recorded in the assessment documentation and a plan of activities to meet these was being developed. The plan was looking at physical, psychological and social activities. The number of activities now being done with residents had increased and records were being kept of these. On the day of the visit several residents played bingo. 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. Linden House Residential Home DS0000022493.V326568.R01.S.doc Version 5.2 Page 16 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. On the day of the visit there were a large number of residents up and dressed by 8.00 am. Not all of these residents were able to say whether they wished to get up or not. From these observations and discussion with night staff it was evident that residents were got up and put to bed in line with staff routines. The lack of information about residents preferred routines meant that their diverse wishes were not known and acted upon. Visitors were welcome to visit at any time and were offered refreshment. A visitor spoken to said that the staff made them welcome when they arrived and were easy to talk to. There was 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 day’s meal was displayed in the dining area. This meant that residents were aware 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 these and fresh fruit and salad were seen. There was a Cook on duty every day and usually a kitchen assistant. Accurate records of storage temperatures were now being kept. A member of staff was seen assisting a resident with their diet. There was no interaction from the staff member during this period of time. This meant that the resident was not given an explanation of what was happening, or a description of what they were being given to eat, or any social stimulation. Linden House Residential Home DS0000022493.V326568.R01.S.doc Version 5.2 Page 17 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 good. 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 a record system for any complaints received by the home. Since the previous inspection the Commission had received one concern about Linden House, which was forwarded for them to investigate. This was done appropriately and a written response sent. There was no record in the home’s complaints book of this. The Safeguarding Adults procedure had been updated. This gave good information and was clear about who any incident should be reported to. Some staff had signed to say that they had read this. Safeguarding Adults training had been done by some staff but not all. Arrangements were being made for places on further courses. A member of staff who had not received this training was unsure of whom else apart from the manager that they could report things to. Linden House Residential Home DS0000022493.V326568.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: Since the previous inspection a number of improvements had been made to the environment of the home. The reception area had been decorated and there was new furniture. This gave a pleasant welcome to anyone entering the home. There were new carpets in the lounges and corridors. Decoration to the corridors had improved. Some bedrooms had been decorated and had new bed linen, furniture and floor covering. New windows had been fitted in some bedrooms. All these made the home look more homely and a more comfortable place to live. A new cleaning schedule had been introduced with the result that the overall standard of cleanliness had improved. Linden House Residential Home DS0000022493.V326568.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. Several dining rooms chairs were stained. There was mismatched furniture and hospital linen in some bedrooms that detracted from a homely environment. There was no lockable storage for residents in their rooms. Although the courtyard was not as cluttered as before there was evidence that it was used for storing some unwanted items, for example, furniture. There was still evidence of a problem with damp around windows, on walls and some ceilings. The General Manager said that the roof had been repaired and redecoration was planned. Some double rooms were being used as a single bedroom. Discussion took place on the need for this to be clarified on admission and a record of the discussion. This is so that there are no misunderstandings about whether the resident would be expected to share the room at a later date. The laundry was a separate room. It had two washers, one with a sluice programme, and two dryers. There was a sink but no liquid soap, paper hand towels or gloves available for dealing with soiled items. There was a sluice on each unit that were kept locked. Linden House Residential Home DS0000022493.V326568.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 good. 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 more thorough and protected residents. Staff were now being provided with sufficient training to competently undertake activities expected of them. This meant that they knew how to meet resident’s needs. 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, afternoon and evening. The number of night staff was reduced to two on some days. This was insufficient for the size and layout of the building and also did not taken into account the potential needs of those residents with dementia. The Registered Manager said that she did on-call duties. There were no records of how often and when she had been called out and been on duty as a result of this. Two new employees had been recruited since the last inspection. The records of these were examined and showed that more thorough procedures were now being followed. They had completed an application form, references from last employers had been received, and a POVA First check had been received prior to employment starting. A Criminal Record Bureau check had been received. Linden House Residential Home DS0000022493.V326568.R01.S.doc Version 5.2 Page 21 The application form for one employee had gaps in employment and there was no record that these had been explored at interview. There were policies and procedures to ensure that all prospective employees were offered an equal opportunity for employment. Induction training was being given to new employees and records of this were seen. The programme was following the Skills For Care 12 week Induction programme. A new Induction and Staff Handbook booklet with relevant information for staff was to be developed and implemented. Some staff had done training in safe working practices and arrangements were being made for a ‘rolling programme’ so that everyone would have opportunity to attend. Some staff had done Dementia training. This had been a half-day on dementia awareness and some had also done a half-day course on the use of reminiscence. Some staff were receiving in-house training on dementia by a Psychologist but there were no records of this. There were 20 care staff of which 11 had the Nation vocational Qualification level 2 in care. Other staff were enrolled on the course. Linden House Residential Home DS0000022493.V326568.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, 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. Health, safety and welfare of residents and staff had improved due to the training being given. 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 the home was being well managed. Linden House Residential Home DS0000022493.V326568.R01.S.doc Version 5.2 Page 23 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. Resident meetings were now being held monthly but minutes of these were not available at the time of the visit. A Senior Carers meeting had been held and there were minutes of this. A general meeting for carers meeting was to be held. Surveys were being developed for residents and relatives to complete. The Manager was appointee for two residents. Their benefits were paid into Linden House’s bank account and their personal allowance monies stayed in this bank account until needed. One of these residents was receiving a lower personal allowance than he should do. This was part of an on-going investigation from his previous placement. However, this meant he was being penalised for events outside his control. 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 no records of fees charged and paid or invoices available for inspection. The Commission was not being informed of events that affected the welfare of residents. For example there was no record of two residents receiving medical treatment via the ambulance service. There were records to show that the safety of the building was monitored. All appliances were serviced as required. Some staff had received training in safe working practices and courses were being arranged for other staff. Accident records were kept. Chemicals were not as secure as they should be. There was a pink substance in an unmarked bottle with no indication of what this was or any first aid directions. Steradent was seen in an en-suite in the dementia unit. There was the potential for residents to use these inappropriately and harm themselves. Linden House Residential Home DS0000022493.V326568.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 2 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 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X 2 2 Linden House Residential Home DS0000022493.V326568.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 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.(Previous timescale of 31/07/06 not met) Each resident must have a contract that gives details of the total fee payable in respect of the services provided and the arrangements for the payment of this. 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) Wherever practicable the resident or their representative must be consulted about the plan of care.(Previous timescale of 31/08/06 not met) Risk assessments for health related issues must be undertaken for all residents and kept under review. The Manager must ensure that DS0000022493.V326568.R01.S.doc Timescale for action 31/03/07 2 OP2 5(1)(b) (b) 30/04/07 3 OP7 15(1) 31/05/07 4 OP7 15(1) 31/05/07 5 OP8 13(4)(c) 31/05/07 6 OP9 13(2) 28/02/07 Page 26 Linden House Residential Home Version 5.2 7 OP9 13(2) 8 OP9 13(2) 9 OP9 13(2) 10 OP10 12(4)(a) 11 OP14 12(2)(3) 12 OP18 13(6) 13 OP19 23(2)(b) & (d) 13(3) 14 OP26 15 16 OP27 OP27 18(1) Schedule 4 the Controlled Drug book is an accurate record of the Controlled Drugs held at the home. The policies and procedures for the control of medications must be precise in the directions they give to staff. There must be a risk assessment and a plan of care for covert medication to ensure that this is given in a safe manner to the resident. Accurate records must be kept of the medications administered to residents. If these have been omitted a reason for this must be recorded on the chart. The personal clothes of residents must be returned to the correct room so that they are not used for others. 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 Protection of Vulnerable Adults.(Previous timescale of 30/09/06 not met) The schedule of work must be continued to ensure that the whole environment is kept suitable for purpose. There must be suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. There must be three staff on waking watch at night. There must be a record of the hours worked at the home by those staff who do ‘on-call’ duties and have to come in for duty. DS0000022493.V326568.R01.S.doc 30/04/07 28/02/07 22/02/07 28/02/07 31/03/07 31/05/07 30/06/07 28/02/07 22/02/07 22/02/07 Linden House Residential Home Version 5.2 Page 27 17 OP29 19 Schedule 2(6) 18(c)(i) 18 OP30 19 OP33 24 20 OP35 20 There must be a full employment history, together with a satisfactory written explanation of any gaps in employment, for each employee. All staff must receive training in: fire safety; moving and handling; infection control; basic food hygiene; and first aid. (Time scale of 31/12/05 not met) A system for reviewing and improving the quality of care must be established and maintained. (Time scale of 24/10/05 not met). Safe arrangements must be made for residents’ monies. They 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. 22/02/07 30/06/07 30/06/07 31/03/07 21 OP37 Schedule 4 (8) 22 OP37 37 Schedule 3 23 OP38 13(4)(a) 28/02/07 There must be a record available of the care home’s charges to service users, including any extra amounts payable for additional services not covered by those charges, and the amounts paid by or in respect of each service user. There must be a record of all 22/02/07 accidents to residents. Any serious injury or event that affects the wellbeing of residents must be notified to the Commission. All chemical and harmful 22/02/07 products must be clearly marked and stored securely. Linden House Residential Home DS0000022493.V326568.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 2 3 4 Refer to Standard OP2 OP3 OP7 OP9 Good Practice Recommendations The contract should specify the room number that is to be occupied by the resident. The pre-admission assessment used by the home should gather full and complete details about the prospective resident’s needs. The review of the residents’ care plans should state an indication of whether the care being given is effective or not. 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. Eye drops should be dated on opening. Notices relating to resident’s care should not be on display in their rooms. 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. Staff should ensure that they interact with residents when giving them care. There should be a record of all complaints made about the home. 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 whether staff have undertaken 3 days training in each 12 month period. 5 6 OP10 OP14 7 8 OP16 OP30 Linden House Residential Home DS0000022493.V326568.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way 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. 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