Inspection on 29/09/05 for Linden House Residential Home

This inspection was carried out on 29th September 2005.

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 19/06/06

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 29th September 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Linden House Residential Home DS0000022493.V253250.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V253250.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Linden House Residential Home Address Delph Lane Blackburn Lancashire BB1 2BE Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01254 690669 Mr Keshav Savdas Khistria Mrs Kirti Khistria Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (39), Physical disability (1) of places Linden House Residential Home DS0000022493.V253250.R01.S.doc Version 5.0 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 31st May 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 39 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 Manager has now been appointed to be responsible for the day-to-day management of the home and an application for registration with the Commission is being processed. 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 comprises of a mixture of 24 single and eight shared bedrooms. Six of the single bedrooms have en-suite toilet facilities. There is a large combined lounge/dining room located centrally in the home. Linden House Residential Home DS0000022493.V253250.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over one day on the 29th September 2005. There were two Inspectors for this inspection. The previous inspection was done on 31st May 2005 and information on the findings of this can be obtained from the home or from www. CSCI.org.uk . Two additional visits had been made since the previous inspection. One was on 16th August 2005 and was made to monitor progress towards meeting the requirements identified on the inspection in May. The other visit was made on 19th September 2005 and was made to investigate a complaint about care practices. The majority of the allegations were upheld and a number of requirements were made. On the day of the inspection there were 27 residents at the home. Information was obtained from staff records, care records, and policies and procedures. Information was also got from talking to 7 service users, one member of staff and the Manager. Five comment cards were received from residents and six comments cards from relatives/visitors. Three comment cards were received from GPs who had patients at the home. Wherever possible the views of residents were obtained about their life at the home. Due to memory and communication difficulties, many of the residents were unable to engage in conversation or make comment about their experience of living in the home. Detailed notes were taken, which have been retained as evidence of the inspection findings. What the service does well: What has improved since the last inspection? Linden House Residential Home DS0000022493.V253250.R01.S.doc Version 5.0 Page 6 The amount of training offered to staff had been significantly increased. Some staff had received mandatory training in health and safety subjects and were enrolled on the NVQ 2 in care course. This meant that some staff were receiving the knowledge and skills they needed to enable them to do their work in a competent manner and to fully meet residents’ needs. The amount of activities on offer to residents had increased. The residents spoken to said that they enjoyed bingo the most and played this whenever they could. One resident said, “We played bingo yesterday and I won three times. I also play dominoes with some visitors to another resident. They come every day and we play until 9.00 pm.” The residents said that there had been an entertainer playing music and singing songs the previous day. Four of the comment cards from residents said that they felt that the home provided suitable activities. The opportunity to be involved in activities means that residents’ quality of life is enhanced. Residents now had written information on how to make a complaint if they were not happy about something at the home. The manager was recording any complaint that was made to her. She also recorded what she had done about it. Four of the comment cards from residents said that they knew who to speak to if they were unhappy with their care. The amount of sick leave and absences taken by staff had considerably reduced since the new manager started in post. This indicated that there was a greater morale among the staff. Staff meetings had been started and also a system where staff received ‘supervision’ (one-to-one discussion with a senior person) had started. This meant that staff could bring up issues of concern to them. The standard of record keeping had improved, with the majority of the records required to be kept being available. What they could do better: Following admission a plan of care should be prepared that sets out all of the resident’s personal, health and social care needs. The plan must tell staff precisely how they should meet these 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. The daily record written about each resident should contain details about their condition, behaviour and the care given to them. Two of the comment cards from relatives stated that they were not consulted if the resident was unable to make decisions about the care they received. Medication is an important part of care that a resident receives and all staff that administer medicines should be competent to do so. They must read the home’s policies and procedures so that they know what is expected of them. The staff must ensure that the management of medications includes proper Linden House Residential Home DS0000022493.V253250.R01.S.doc Version 5.0 Page 7 and accurate recording of medicines received into the home and given to residents. In order to ensure quality of daily life staff should ensure that residents’ routines are in their best interests. This would include the time they get up in the morning. One resident gave the example of being got up at 6.00 am and not being happy about this as she then had to “wait hours for breakfast”. The amount and range of activities should be increased and should take into account residents’ interests and past hobbies. Access to local community events should also be explored as well as in-house activities. The décor, furnishings and cleanliness of the home were quite poor. In order to make this a clean and comfortable place for residents to live an audit should be done of all the repairs, redecoration and refurbishment needed. A schedule of works to complete these must then be done and carried out. All staff must receive a minimum of 3 days paid training each year. This training must cover 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 amount of self-auditing must be extended. This would enable the Manager to identify areas that needed attention and to create an action plan to resolve these. All of the records required to be kept must be at the home and be available for inspection. This is so that the efficient management of the home can be monitored. Records of the freezer, fridge and cooking temperatures must be kept daily and be accurate. This is so that the safety of the food stored and served can be monitored. 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.V253250.R01.S.doc Version 5.0 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.V253250.R01.S.doc Version 5.0 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): 2, 3 and 4 The admission procedures meant that residents now had their needs assessed before moving into the home. Residents were issued with a copy of the contract so that they knew the terms and conditions of residency. Training had been commenced for staff to enable them to undertake their duties in a competent manner. EVIDENCE: The files of three residents were viewed. One of these residents had been admitted since the new manager started at the home. This person had an assessment of their needs prior to moving into the home. The other two residents had been admitted prior to this and there was no evidence that their needs had been assessed before they came to live at the home. The manager assured the Inspectors that the current procedure was that no one was admitted to the home without an assessment of needs being done. There was a copy of the home’s terms and conditions of residency in each file viewed. The residents had signed these. Linden House Residential Home DS0000022493.V253250.R01.S.doc Version 5.0 Page 10 Staff had done some training and more was being arranged in a number of topics. These meant that staff were gaining knowledge and skills in order for them to be able to undertake their duties in a competent manner and meet the needs of the residents. Linden House Residential Home DS0000022493.V253250.R01.S.doc Version 5.0 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 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 records had improved but administration 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: The plans of care are important documents as they direct staff on the actions that they need to take on a daily basis to meet the needs of the service users. Lack of accurate information in these can potentially lead to these needs not being met and/or inconsistency of care. The files for 3 residents were viewed. The style of paperwork used for the plans of care did not lend itself to being easy to use or understand. There were areas where information should be recorded or repeated but these were not always being completed properly. Also, the space allocated for directions was small. This did not allow for sufficient detail to be written so that staff knew how to meet the resident’s individual needs in respect of all their activities of daily living. Therefore, 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, one Linden House Residential Home DS0000022493.V253250.R01.S.doc Version 5.0 Page 12 resident’s mental health assessment on admission identified that she had low mood and bereavement issues, one resident was having wandering behaviour at night and another resident was showing behavioural problems. There were no directions for staff on how to deal with these problems and needs. The daily notes written on residents mostly said “ Appears fine, no change”. This was not sufficient information on the condition, health and care given. The plans of care were being reviewed each month and there was evidence that the residents had been invited to sign their plan. 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. The District Nurse visited two of the residents whose files were viewed and there was evidence her records were kept in the home. There were records to show that the Chiropodist had visited. The condition of one resident and his room was brought to the attention of the manager. When the Inspectors went into his room he was dressed in stained pyjamas with the hospital logo. He was barefoot and his feet looked cold and blue. The sheets on his bed looked dirty and his commode was badly stained with faeces. The laminate wood flooring did not appear to be fitted properly and was ‘sticky’ and dirty in places. The room was malodorous. The manager said that the flooring was due to be replaced but did not have a specific date for this. The resident was later attended to by a member of staff and he was changed into clean pyjamas and his commode cleaned. The Manager was informed that this resident should be moved to a cleaner and more suitable room until his flooring was repaired and his personal hygiene and care monitored by herself to ensure that this is being done as required. Only one of the files viewed had brief details of what the resident wanted in respect of dying and death. Whilst this is a sensitive issue to be discussed, recording of wishes before the event can ensure that these can be respected and carried out as the resident would like. The plans of care viewed stated that staff should promote independence, privacy, dignity and choice, but were not specific about how to do this. A resident said, “The staff knock on the bathroom door, they don’t just barge in”, A member of staff spoken to said that she had not had any formal training in privacy and dignity but had learnt by example. She was able to describe the principles of privacy and dignity. However, during the complaint investigation on 19th September 2005 there were serious issues about promoting resident’s dignity and a requirement was made about this at that time. The medication storage area was clean and tidy and the temperature of the room and fridge were recorded daily. The trolley was secured correctly. There were policies and procedures for staff to refer to about the control of medications. These had been extended since the previous inspection. They Linden House Residential Home DS0000022493.V253250.R01.S.doc Version 5.0 Page 13 were supposed to be signed by staff to show that they had read these. Not all of the medications received into the home were being recorded. This was felt to be due to the system being used and an alternative method was discussed. There was a discrepancy between the number of tablets received for a resident, the number of tablets administered and the number remaining. It was unknown whether they had been used for another resident, given by mistake to someone, or used by staff. There was a bottle of Piriton for one resident, which was partly used. This was not recorded on her Medication Administration Recording chart as being prescribed, there was no record of it having been received into the home and no record of it being administered. These issues raise concerns about the competence of the staff who are administering medications. There were records of medications returned to the Community Pharmacist. Hand written annotations to the Medication Administration Records were not signed or witnessed. Linden House Residential Home DS0000022493.V253250.R01.S.doc Version 5.0 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, 14 and 15 Some activities were now being offered to and being done with residents so that their recreational needs could be met. The amount of choice and control residents exercised over their life was dependent on their ability to make decisions. The lack of accurate records meant that the safety of the food stored and served could not be guaranteed EVIDENCE: The care plan documentation had space for recording a social and leisure assessment for the resident. This included any particular interests, hobbies or recreational likes. These were found to be either partially completed or to contain inaccurate information. For example, one resident’s assessment stated that he hated bingo, but he was seen to enthusiastically join in a game on the day of inspection. There was an activities folder that recorded what activity had been done and who had joined in. Some residents were able to pursue their own individual interests. These included knitting and crosswords. The manager stated that there was a trip arranged to Lancaster in the near future. One resident had told the Inspectors that she would like to go out but when she asked about this was told that staff were too busy to take her. The manager said that residents had been offered trips out individually but won’t go. Linden House Residential Home DS0000022493.V253250.R01.S.doc Version 5.0 Page 15 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. The records for the day of inspection showed that the night staff had got up 12 residents that morning. Some of these were unable to make their wishes known and it was difficult to determine whether they were happy to get up prior to 8.00 am. The member of staff spoken to said that they usually try to get everyone up by 9.30 am. The records of fridge and freezer temperatures were not accurate. The actual temperature was not being recorded each day, just a dash to indicate that it was the same as the day above. On the day of the inspection the ‘dash’ indicated a temperature of 10 º, but the actual temperature was – 23 º C. There was difficulty finding the thermometers in two of the freezers, giving the impression that these had not been available for taking the temperatures that morning. There were records for the cooking temperatures of foods for Monday through to Friday, but these were not being recorded at weekends. This meant there was the potential for the safety of the food stored and served to be compromised. Linden House Residential Home DS0000022493.V253250.R01.S.doc Version 5.0 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 Residents had information about how to complain and that these would be taken seriously and acted upon. Training was in the process of being given to staff 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 two complaints 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 complaints about Linden House. One was forwarded to the home to investigate and the result of this then sent to the Commission. The investigation done by the home found the allegations to be true and appropriate action was taken by the home. The Commission investigated the other complaint and the majority of the allegations were found to be true. A report of this investigation, giving requirements and recommendations, has been issued to the registered providers. As a result of the complaint investigated by the home one member of staff has been dismissed and referred to the POVA list. Each member of staff has also received a copy of the Whistle blowing procedure. Twelve staff have received in-house training from a Manager from another home about prevention of abuse and protection of vulnerable adults. Two members of staff are to attend the Blackburn with Darwen Borough Council training on Protection of Vulnerable Adults in October 2005. Linden House Residential Home DS0000022493.V253250.R01.S.doc Version 5.0 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 The lack of adequate maintenance and redecoration meant that residents could not be assured of a safe and comfortable home. Although the level of cleanliness had improved the entire premises were not clean and hygienic. EVIDENCE: A section of the home was viewed. This showed that adequate maintenance of the premises was not being kept up, that the standard of decoration and furnishings was poor and that the cleanliness and hygiene needed to be improved. This has been identified as a requirement on the previous inspection and for the registered persons to submit a schedule to show how this will be resolved. No such schedule has been received. Arrangements had been made with external Contractors, but they had not come to the home when they were due to. This meant that maintenance issues had not yet been attended to. Some minor efforts have been made to resolve some of these issues: some new chairs in the lounge area; individual bedrooms have received some ‘patching’ up. However, the overall appearance of the home was very poor. For example: walls in the corridors, toilets, and some bedrooms were scuffed and dirty; doors to rooms were scuffed and gouged; commodes in bedrooms had Linden House Residential Home DS0000022493.V253250.R01.S.doc Version 5.0 Page 18 ripped covers or looked unclean; ripped, stained and dirty bedding was seen on residents’ beds; sheets with the logo of local hospitals were seen on residents’ beds; floors were stained and ‘sticky’ underfoot; windows required cleaning; a handle was missing from an en-suite door; a door was missing from a wardrobe; divan bases were stained; and there was a nasty odour in some rooms. The laundry walls had not been fully cleaned. Linden House Residential Home DS0000022493.V253250.R01.S.doc Version 5.0 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 There were sufficient numbers of staff on duty to meet the needs of the residents. Staff shortages had been addressed and as a result residents were receiving care from regular staff. Recruitment procedures had improved but these could not be tested, as there were no new employees. The current level of staff training needed to be increased 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. Two of the comment cards from relatives stated that they felt that there were was not always sufficient staff on duty, although this was not evidenced on the day of inspection or by the duty rotas. One of these cards also said that they felt that the staff ‘were under a lot of pressure’. No new staff members had been employed since the visit made on 16th August 2005. At that time the recruitment procedures were still not of a standard to ensure that residents were safeguarded. Since then the application form to be issued to potential staff had been amended so that it contained correct information about the Rehabilitation of Offenders (Exceptions) Order. A letter to be used for character references had also been created. As no new staff had commenced employment a judgement could not be made as to whether the first day and six week induction programme was being done correctly. The Manager said that she had arranged for 12 staff to do the Skills Linden House Residential Home DS0000022493.V253250.R01.S.doc Version 5.0 Page 20 for Care Induction course in October. Although some of these staff had been employed for a long period of time she felt that it would be beneficial to them as a refresher of their knowledge of care principles. Other training was also being done with staff, which was mostly mandatory training. There was a wipe clean board with details of training undertaken by staff which the Manager used as an ‘overview’ of training done. This did not contain dates of when the training was done. Whilst this was satisfactory for this year it would be difficult to determine next year whether each member of staff had received three days training in each period of twelve months. There were only two carers of the 19 employed who had the NVQ 2 qualification, which meant that only 11 of staff had this qualification. The manager said that there were 12 staff currently enrolled on the course and two of these were nearing completion. Linden House Residential Home DS0000022493.V253250.R01.S.doc Version 5.0 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 There was an improvement to the day-to-day running of the home by the recruitment of a Manager. A system of supervision for staff had been commenced. The internal auditing systems could be improved upon to ensure that the home is run in the best interests of the residents and that the quality of care is appropriate for them. The standard of record keeping had improved with the result that important information was now being kept and was available for inspection. All staff had not yet received training in mandatory subjects, which meant that the health, safety and welfare of residents and staff might not be fully promoted and protected. EVIDENCE: The overall morale of staff had improved since the recruitment of the new manager. Systems were being put into place to promote effective management of the home. Some internal auditing had commenced in order to determine the quality of care being given. This included audits of care plans and medication. These audits were not formally accredited to any quality assurance system. Linden House Residential Home DS0000022493.V253250.R01.S.doc Version 5.0 Page 22 Staff meetings and residents meetings were being held so that views on how the home was run and any suggestions for changes could be obtained. Residents had completed a survey in June 2005. The results had been put into a graph form but there was no plan of action to address any shortcomings. The amount of money held on behalf of residents was now within the insurance levels. A system of supervision for staff had been started, along with staff appraisal. This had only been commenced recently. The records kept within the home were complete except for: reports of the Regulation 26 visits; residents’ fees and the amounts paid; and a record of any furniture brought into the home by a resident. Training for staff in health and safety issues had been commenced. 10 staff had done fire safety training; 17 staff had done moving and handling training; 17 staff had done first aid awareness but only the manager was a qualified first aider; 12 staff had done Protection of Vulnerable Adults training and 11 had done basic food hygiene. Whilst this was a significant improvement since the last insepction it is imperative that all staff receive mandatory training and update this each year. The standaid was due to be serviced in October 2005. Linden House Residential Home DS0000022493.V253250.R01.S.doc Version 5.0 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 X 3 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 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 3 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 2 2 Linden House Residential Home DS0000022493.V253250.R01.S.doc Version 5.0 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 OP7 Regulation 15(1) Requirement 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 24/09/05 not met. This was an extended time frame from previous inspections) 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 timescales of 03/12/04 and 17/06/05 not met) All staff who administer medication must receive accredited training and their competence must be assessed. (Previous timescale of 31/07/05 not met) The privacy and dignity of residents must be respected. This would include ensuring that residents’ state of dress and cleanliness is monitored. The wishes and feelings of a specific resident in respect of the DS0000022493.V253250.R01.S.doc Timescale for action 30/11/05 2 OP9 13(2) & 17(1)(a) 31/10/05 3 OP9 13(2) 31/10/05 4 OP10 12(4)(a) 30/09/05 5 OP14 12 31/10/05 Linden House Residential Home Version 5.0 Page 25 6 OP15 7 OP19 8 OP19 9 OP30 10 OP33 11 OP37 12 OP38 time that she gets up in a morning must be discussed with her and arrangements made for her wishes to be followed as far as is practicable. The discussion and the outcome should be recorded in the plan of care. 16(2)(j) Appropriate records relating to the storage, cooking and serving of food items must be kept.(Previous timescale of 30/06/05 not met) 23(2)(b) A room audit must be done that & (d) identifies all the repairs, redecoration and refurbishment needed to bring the whole environment of the home up to an acceptable standard. 23(2)(b) A schedule of work to show how & (d) the issues identified in the room audit are to be addressed must be submitted to the Commission. (Previous timescale of 24/07/05 not met) 18(1)(c) All staff must receive a minimum of three days paid training each year to enable them to have the skills and competencies to undertake their work. 24 A system for reviewing and improving the quality of care must be established and maintained. 17 All records required to be kept Schedule under this Schedule should be 4 present in the home. (Previous timescales of 31/12/04 and 24/07/05 not met) 2394)(d) All staff must receive training in: & 18(c)(1) fire safety; moving and handling; infection control; basic food hygiene; and first aid. 31/10/05 31/10/05 30/11/05 31/12/05 24/10/05 31/10/05 31/12/05 Linden House Residential Home DS0000022493.V253250.R01.S.doc Version 5.0 Page 26 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 Refer to Standard OP4 OP7 OP9 Good Practice Recommendations Training for staff should continue so that each member of staff receives sufficient knowledge and skills to enable them to undertake their duties in a competent manner. The daily notes should contain an adequate statement on the resident’s behaviour, health, condition and what care has been received. 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. There should be a formal system for prompting medication reviews in line with National Service Framework for Older People Staff should familiarise themselves with the homes policies and procedures for medicines management. 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. The details available to staff on the social interests of residents should be accurate. The range of activities offered to residents should be extended to ensure that they are given ample opportunity to make local outings. 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. The manager should ensure that the person giving the Protection of Vulnerable Adults training is qualified to teach the subject and is aware of the Blackburn with Darwen Borough Council’s procedures. Arrangements should be made to ensure that the staff members who have not attended the Protection of Vulnerable Adults do so in the near future. The walls of the laundry should be cleaned. Staff should be encouraged to undertake the NVQ 2 qualification so that 50 of the staff have this by the end of 2005. Dates of training undertaken should be put on the training matrix so that there is an easy method of determining DS0000022493.V253250.R01.S.doc Version 5.0 Page 27 4 5 6 7 OP9 OP9 OP11 OP12 8 9 OP14 OP18 10 11 12 13 OP18 OP26 OP28 OP30 Linden House Residential Home 14 15 OP36 OP38 whether staff have undertaken 3 days training in each 12 month period. A programme of supervision dates should be set to ensure that all staff receive this 6 times in each year. Confirmation should be forwarded that the standaid has been serviced. Linden House Residential Home DS0000022493.V253250.R01.S.doc Version 5.0 Page 28 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.V253250.R01.S.doc Version 5.0 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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