Inspection on 31/05/05 for Linden House Residential Home

This inspection was carried out on 31st May 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 29/09/05

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 Janet Proctor Unannounced 31 May 2005 09:30 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 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 F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Linden House Residential Home Address Delph Lane Blackburn Lancashire BB1 2BE 01254 690669 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Keshav Khistria Mrs Kirti Khristria Care Home only Personal Care (PC) 40 Category(ies) of Learning disability (LD) 1 registration, with number of places Old age, not falling within any other category (OP) 39 Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 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. Date of last inspection 02 November 2004 Brief Description of the Service: Linden House is a care home that is currently registered to provide personal care for 39 older people and 1 adult with a learning disability.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. 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 F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place with two regulation inspectors over thirteen hours on the 31st May and 1st June 2005. The pharmacy inspector was present and assessed the control of medications. The previous inspection was done on 2nd November 2005 and information on the findings of this can be obtained from the home or from www. CSCI.org.uk . Four additional visit had been made since the previous inspection, one monitoring visit and three visits to investigate complaints. Information was obtained from staff records, care records, and policies and procedures. Information was also got from talking to 9 service users, the Manager, one of the registered providers, 4 staff members and 2 visitors. The Manager had only been in post for 3 weeks and was still not fully familiar with all aspects of the home. On the day of the inspection there were 29 residents at the home. Wherever possible the views of residents were obtained about their life at the home. Some 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? A Manager with relevant experience and qualifications had been appointed. Although she had only been in post for a matter of weeks there was a significant improvement in the morale of staff. Staff meetings had commenced with the result that carers felt that they could express their views and opinions Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 6 and that these were being listened to. The Manager had also made an improvement to recruitment of staff. For those she had employed she had ensured that correct procedures were followed before a member of staff started work at the home. The standard of cleanliness in the home had improved since the last inspection. Bedrooms in particular were seen to be cleaner than on previous visits. Residents spoken to were happy with their rooms. All residents recently admitted had evidence that an assessment of their needs had been done before they were admitted to Linden House. A letter was then sent to the resident telling them whether their needs could be met. 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 use of risk assessments must be included so that all risks are identified and actions taken to minimise these. There should be sufficient equipment available e.g. spare slings for the hoist, so that residents can follow their preferred and usual daily routines. Accredited training should be given to all staff that administer medicines. The staff need to ensure that the management of medications includes proper and accurate recording of medicines given. In order to promote independence, wherever possible residents should be allowed to administer their own medication if they have been assessed as safe to do so. The amount and range of activities must be increased. Residents spoken to said “There’s not enough to do”, “We play dominoes but not so often. We play bingo on a Monday but nothing else goes on”” and “I don’t sit in the lounge because there’s no one to talk to”. This lack of activities detracts from residents’ quality of life. Access to local community events should also be explored as well as in-house activities. The number of staff on duty must be consistently enough to meet the needs of the residents. Staff need to be able to fill any shortfalls in the number on duty. The safeguarding of residents is paramount and the recruitment procedures must continue to be strengthened to ensure that all required documentation is obtained before employment begins. The amount and type of training given to staff must be increased to ensure that they have the relevant skills, knowledge and competence to do their work. Training must be provided in all aspects of care, health and safety, protection of vulnerable adults, moving and handling and fire procedures in order to protect residents and staff. Regular supervision by a senior member of staff Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 7 should also be done to ensure that any training needs or deficiencies in performance are identified. 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 F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 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 standard(s) 1, 2, 3, 4 and 6 Sufficient information was available to enable prospective service users to make an informed choice about whether they wished to live at the home. The admission procedures meant that residents had their needs assessed before moving into the home. The lack of training for staff and a limited supply of some equipment meant that residents’ needs were not fully met. EVIDENCE: As requirements were made at the previous inspection for standards 1, 2 and 4, these were monitored on this inspection. The Statement of Purpose was now found to contain information about the home, facilities and service provided. The files of the residents that were viewed contained evidence of a contract stating the terms and conditions of residency, as required for standard 2. This had not been signed by either the resident or their representative, meaning that there was no evidence that they had agreed to these terms. There was a copy letter that had been sent telling the resident that the home could meet their assessed needs, as required for Standard 4. The resident files viewed showed that a Care Management assessment had been obtained before the resident was admitted. The residents spoken to said “They look after me very well” and “I feel more safe here”. The staff spoken to Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 10 said that they felt that they needed more training, especially in basic care issues, so that they were able to meet all needs. One service user was unable to have a guarantee that she could stay up as long as she liked. If her sling to the hoist was being washed she had to stay in bed, as staff were then unable to move her. There was no spare sling for her and she had been told that she would have to purchase another herself. Intermediate care was not given at Linden House. Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9, 10 and 11 There was no clear and consistent care planning system in place to adequately provide staff with the information they needed to satisfactorily meet residents’ needs. Whilst medication policies and procedures were in place, these were not reflective of current practice. Staff had not received formal medicines management training and this placed residents at risk. Residents felt they were treated with respect. 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 4 residents were viewed. Two of these residents had been admitted in December 2004 and February 2005 but did not have a plan of care. For the other two files seen, 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. The plans of care were not reviewed monthly and this meant that the information in them was not always accurate. The files seen showed that the plans of care were not completed in Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 12 consultation with either the resident or their family. There were some residents who could give their views and opinions on the kind of care that they wanted or needed. One visitor spoken to said that no one had gone through his father’s care plan with him. 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; and moving and handling needs. Not all the files viewed had these in place. Neither was there full detail on how to meet health needs, which was of particular concern for one resident who was an insulin controlled diabetic. A staff member spoken to did not know how to recognise the signs and symptoms of a diabetic coma. There was also incorrect information in the plans of care. One such plan stated that a resident had a catheter, but this had been removed some months ago. The increasing aggressive behaviour of a resident meant that staff were unable to manage him. A risk assessment had been done, but this did not contain any directions for staff to follow. Bed-side rails were being used without a risk assessment on the use of these. This meant that there was the potential for the resident to be harmed by the use of this equipment. Only one resident looked after some of their own medication although risk assessments had not been completed and secure storage was not available. Another resident had expressed an interest in self-medication but this request had not been considered. Accurate administration and documentation of medication by trained staff is essential to the health and well being of residents. Full records of medication taken were not available for each resident, and there was confusion over the use of codes on Medication Administration Record charts leading to unclear records. Staff had not received medicines management training. The residents said that the staff respected their privacy and gave examples of how they did this, “They always knock on the door” and “When I’m on the bed pan they always cover me up and close the door”. The staff spoken to were able to describe the principles of privacy and dignity. Only one plan of care seen had good details of what the resident wanted in respect of dying and death. There was space on the contract for these details to be entered, but this had not been completed on the contracts seen. Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 12, 13 and 15 The lack of recreational activities and local and community contact meant that residents’ social interests and needs were not being met. The daily routines for residents matched their preferences and choices. Residents were able to have family and friends visit them. The food served at the home was to the liking of the residents but the lack of accurate records meant that the safety of the food could not be guaranteed. EVIDENCE: The residents were able to make choices about aspects of their lives wherever practicable. They could stay in their room whenever they wanted to and could eat their meals there if they wished. Staff said that the residents could make a choice about what time they got up and went to bed and could stay in bed all day if they wished to. Residents said that very little activities were done. The staff said that they tried to do activities with the residents but did not always have time for this. One visitor spoken to said that he wished to take advantage of the nice weather during the summer months and take his father out for day trips. He’d been told that this could not occur until his father had had a ‘health check’. He was told this about 3 months ago and since then nothing had been done. A resident said that she wasn’t allowed to go to Age Concern anymore and said “I really miss that”. Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 14 Visitors were able to come to the home at any reasonable hour. A visitor spoken to was happy with the way that staff made him welcome when he came to the home. A resident said that her son rings her every week from America. Residents spoken to were happy with the meals at the home. They were offered a choice of food at mealtimes and could have alternatives to this if they wished. The menu was displayed and residents knew where this was. The pureed diet was served with all the components of the meal blended together, which meant this did not look attractive and appetising. The lack of recording of fridge and freezer, cooking and serving temperatures had been brought to the attention of the Cook and the management of the home by the Environmental Health Officer on 23rd February 2005. These were still not being recorded and the lack of these meant that there was the potential for the safety of the food stored and served to be compromised. Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 15 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 standard(s) 16 & 18 The residents had not been provided with a clear procedure for making complaints. The lack of accurate recording meant that there was not full evidence that any complaint made had been investigated and acted upon. The lack of staff training in protection of vulnerable adults may result in abusive practices being unrecognised and unreported. EVIDENCE: There was a complaints procedure in the policy and procedure file that had all the details required. There was a complaints procedure on the back of each bedroom door but there were at least 3 different formats of this. This made it difficult for residents to know exactly what to do if they wanted to complain. Residents spoken to said that they did not have any complaints. There was a complaints record book. The last entry in this was for November 2004 and there was no sign of what action had been taken to resolve the complaint. Since November 2004 the Commission has received 3 complaints about the home. The complaints made included allegations about care practices, management practices and staffing levels. The majority of these issues were upheld and requirements and recommendations made. There were policies and procedures for prevention of abuse. Staff spoken to had not received any training on the protection of vulnerable adults and some were not aware of what action to take should an incident occur. Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 16 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 standard(s) 19, 24 & 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: Some of the bedrooms seen had been redecorated and looked quite nice. Some residents had brought their own furniture in and made their rooms very homely and personal. Other bedrooms and most of the corridors were still looking quite ‘shabby’ with scuffed paintwork, the wallpaper torn in parts or peeling from the wall. Locks had been fitted to bedroom doors since the previous inspection but keys had not been offered to all residents. Some of the double glazed windows had a build up of moisture between the panes of glass making them unsightly and visibility from these difficult. The carpet in the lounge was worn in parts and was ‘rising’ with the potential for a ‘trip’ accident to occur. The grounds outside of the house were unkempt and the internal courtyard accessed from the lounge had a pile of old furniture dumped in it and badly needed weeding. This meant that there were no nice areas for residents to sit Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 17 outside and enjoy fresh air and nice weather. There was no formal programme of repair and redecoration and the home was without a handyman. This vacancy had been advertised but not yet filled. The home was much cleaner than on previous visits, although some commodes and equipment in bedrooms were obviously not being cleaned as necessary. The laundry room was separate and contained sufficient washers and dryers. The walls in the laundry needed to be cleaned and there was a collection of unnecessary items in the room. These included items that were flammable e.g. tins of wood stain and pipe putty, and should not be stored in a high risk area such as the laundry. There was no evidence that the home complied with the Water Supply (Water Fittings) Regulations. Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30. Staffing levels did not always meet the agreed minimum, meaning that residents’ needs may not be fully met. The recruitment procedures were not thorough and did not ensure the protection of residents at the home. Staff were not provided with sufficient training to competently undertake activities expected of them, which may result in residents being placed at risk or their needs remaining unmet. 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. Staff spoken to said that they had busy periods but generally there was enough staff on duty so long as no one was absent. If someone was absent they had to cover this from the existing staff group, and this was not always possible. They said that they had been told that they were not allowed to use Agency staff under any circumstances. This meant that there were some instances when the home was not correctly staffed. One resident said “You sometimes have to wait – there’s not always enough staff on”. The new Manager was fully aware of the procedures to be followed and the documents to be obtained in respect of recruitment of staff. The files viewed for those staff she had employed showed an improvement in the standard of information. A member of staff who had started work the day before the inspection gave details of the recruitment procedure that had been done with her. This was correct and proper. There was no evidence of a POVA First check in the file for another staff member recruited before the new Manager was employed. None of the recently employed staff members had a photo on file. Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 19 The full employment history and reasons for leaving needed to be obtained for all prospective employees. Four of the members of staff employed did not have a CRB certificate in their file. The staff members recruited by the new manager had evidence of a first day Induction in their personal file. This was not so for some staff recruited previous to this and one of these was not able to clearly say what she would do if there was a fire in the building. There was no evidence that all staff had received structured Induction and Foundation training and there was a lack of training and learning opportunities for all staff. Staff spoken to said they were willing to learn and would like to have more training. They felt that they had gaps in their knowledge about care issues and wanted to remedy this. There was only 1 member of care staff with a NVQ qualification. Other carers had been enrolled on the course. Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36, 37 & 38 The recruitment of a Manager and the implementation of staff meetings meant that there had been an improvement in the management approach of the home. Staff were not being appropriately supervised with the potential that they might not fully understand their roles and responsibilities. There was a lack of important information on both staff and residents, as full and complete records were not kept at the home. The lack of staff training and documentation meant that the health, safety and welfare of residents and staff were not fully promoted and protected. EVIDENCE: As requirements were made at the previous inspection for standards 31, 32, 36 and 37, these were monitored on this inspection. A Manager had now been appointed as required under standard 31. She has 17 years experience in care work and the NVQ level 4 qualification. An application for registration needs to be forwarded to the Commission. The Manager did not Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 21 have a copy of the roles and responsibilities of herself and the Area Manager. Relationships between management and staff had improved and the views of staff were being taken into account, as required under standard 32. Staff spoken to made positive comments about the new Manager and her approach to them and the residents. She was holding staff meetings for both day and night staff teams. The minutes of these showed that staff still had some unresolved issues with management, especially about pay and terms and conditions of employment. In order to maintain relationships and promote a consistent and stable work force, these should be approached in a constructive manner. The recommendation made under standard 34 for a business and finance plan had not been fully met. There was a business plan but this did not detail the arrangements made for financing of aspects of the business e.g. training. The requirement made under Standard 36 for regular supervision for all care staff had not yet been implemented. The records required to be kept under standard 37 had improved, but still did not cover all those required. The manager had only been in post for 3 weeks and had not yet had time to implement any quality assurance initiatives. Therefore the requirement for a system for reviewing and improving the quality of care had not been undertaken. Also the recommendation for the results of resident’s surveys had not been done. The quality assurance measures at the home will be fully assessed on the next inspection. Each resident had a lockable facility in their bedroom, although not everyone had a key to this. No pensions were collected on behalf of residents. There was a safe in the office for any money managed by staff or for valuables that were handed over to staff. Any money kept on behalf of residents was in individual wallets and there was a record of the amount paid in, withdrawn and the balance. A random selection of these were checked and the actual money tallied with the balance recorded. Some residents had a large amount of money. Not all measures to ensure the health and safety of residents were in place. Staff had not received training in health and safety and safe working practice topics, including fire safety and moving and handling. Some of the staff working in the kitchen had not received Basic Food Hygiene training. There were no risk assessments for the environment or working practices. Records of fire drills were kept. Fire alarms and emergency lighting were checked regularly. There was no work based fire risk assessment. A number of flammable items were stored in the boiler room. Water temperatures were checked monthly. There was a current electrical installation certificate. Portable Appliance Testing was done in April 2005. The servicing of the gas boilers and appliances was overdue. The bath hoist had been serviced in Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 22 December 2004 but there were no records of when the standaid hoist was due to be serviced. Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 2 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 2 x x x x 3 x 2 STAFFING Standard No Score 27 2 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 1 2 2 2 2 2 1 2 2 Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 24 Yes Are there any outstanding requirements from the last inspection? 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 OP4 Regulation 18(1)(c ) Requirement Training in all areas of care work to be given to all staff to enable them to undertake their duties in a competent and confident manner. Ensure that there is sufficient and appropriate equipment to meet the needs of residents. 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 31/12/04 not met. This was an extended time frame from previous inspections) Wherever practicable the resident or their representative should be consulted about the details in their plan of care. (Time scale of 31/12/04 not met. This was an extended time frame from previous inspections) The plan of care must be kept under review. (Time scale of 31/12/04 not met. This was an extended time frame from previous inspections) The health care needs of all residents must be assessed and identified in the plan of care. Where risks are identified there Timescale for action 24th September 2005 24th July 2005 24th September 2005 2. 3. OP4 OP7 23(2)(c ) 15(1) 4. OP7 15(1) 24th September 2005 5. OP7 15(2)(b) 24th September 2005 24th September 2005 Page 25 6. OP8 15(1) Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 7. OP8 13(4)(c ) 8. OP8 13(4)(c ) 9. OP9 13(2) 10. OP9 13(2) 17(1)(a) 11. 12. OP9 OP9 13(2) 13(2) 13. OP9 13(2) must be directions in the plan of care on how to reduce or manage these.(Time scale of 31/12/04 not met. This was an extended time frame from previous inspections) All service users who have episodes of aggressive behaviour must a management strategy documented on their plan of care. This must be understood by staff members, reviewed and updated. A risk assessment must be done on the safety of residents in respect of bed-side rails. Any strategies to reduce the risk or monitoring of the risk should be identified in the plan of care. The manager must ensure that self-medication is promoted where appropriate. Risk assessments must be completed (and reviewed) and the resident provided with secure storage facilities within their private room. 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. (Time scale of 03/12/04 not met) The medicines trolley must be stored securely when not in use. Medicines must only be administered to the resident for whom they were prescribed. There must be no sharing of creams or other preparations. The manager must ensure that there is a detailed protocol and procedure in place for the covert administration of medication within food or drink. Written authorisation for this practice 30th June 2005 30th June 2005 1st July 2005 17th June 2005 17th June 2005 17th June 2005 17th June 2005 Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 26 14. OP9 13(2) 15. OP12 16(2)(m) & (n) 16(2)(j) 13(6) 23(2)(b) & (d) 23(2)(o) 23(4)(a) 18(1)(a) 16. 17. 18. OP15 OP18 OP19 19. 20. 21. OP19 OP26 OP27 22. OP29 19 Schedule 2 must be obtained from the residents General Practitioner. Administration must be recorded clearly. Staff authorised to administer medication must receive accredited medicines management training and have an assessment of their competence to complete these task.(Time scale of 03/12/04 not met. This was an extended time frame from previous inspections) Suitable arrangements must be to enable residents to engage in local, social and community activities Appropriate records relating to the storage, cooking and serving of food items must be kept. All staff must receive training in the Protection of Vulnerable Adults. That a programme of repair, redecoration and refurbishment for all areas of the home is submitted to the Commission. The external grounds must be suitable, safe to use and maintained properly. The tins of flammable materials must be removed from the laundry area. There must at all times be suitably qualified, competent and experienced persons working at the care home to meet the health and welfare needs of the residents.(Time frame of 03/12/04 not met. This was an extended time frame from previous inspections) Satisfactory recruitment procedures must be followed, including obtaining a full and complete employment history and reasons for leaving. 31st July 2005 24th August 2005 30th June 2005 24th September 2005 24th July 2005 24th July 2005 30th June 2005 From date of inspection From date of inspection Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 27 23. OP29 19 Schedule 2 24. OP29 19 25. OP30 18 (1)(c)(i) 26. OP30 18(1)(c ) 27. 28. OP31 OP33 8 24 29. OP35 12(4)(a) 30. OP36 18(2) 31. OP37 17 Schedules 2, 3 & 4 There must be evidence that a POVA First check has been undertakne for new members of staff before they are permitted to commence employment. (Time scale of 03/12/04 not met. This was an extended time scale from previous inspections) All staff employed must a CRB check completed. (Time scale of 31/12/04 not met. This was a extended time scale from previous inspections) There must be a record of structured Induction and Foundation training for all staff.(Time scale of 03/12/04 not met) All staff must receive a minimum of 3 days paid training each year to enable them to have the skills and competencies to undertake their work. An application for registration must be submitted in respect of the new Manager. To establish and maintain a system for reviewing and improving the quality of care provided. (Time scale of 31/12/04 not met. This was an extended time scale from previous inspections) That all residents are provided with a key to the lockable facility in their room, unless the reason for not doing so is explained in the care plan. That all staff are appropriately supervised.(Time scale of 31/12/04 not met. This was an extended time scale from previous inspections) That all records required to be kept are present and kept up to date. (Time scale of 03/12/04 not met. This was an extended time scale from previous From date of inspection 24th August 2005 From date of inspection 31/12/05 30th June 2005 24th October 2005 24th July 2005 24th September 2005 24th July 2005 Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 28 inspections) 32. OP38 23(4)(d) All staff must receive training in: & 18(c )(i) fire safety; moving and handling; infection control; basic food hygiene; and first aid. 13(4)(a) Risk assessments must be (b) & (c) undertaken to ensure that there is a safe environment within the home and that safe working practices are followed 23(4)(a) A work based fire risk assessment must be formulated and reviewed regularly. 23(2)(b) All gas boilers and applicances must be serviced annually by an appropriately qualified person. 24th September 2005 24th July 2005 33. OP38 34. 35. OP38 OP38 24th July 2005 24th July 2005 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. Refer to Standard OP2 OP9 Good Practice Recommendations That the resident or their representative sign the copy of the terms and conditions of residency. 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. Staff should see prescriptions prior to them being dispensed by the pharmacy.Keys to medication storage should be on a separate key ring and only accessible to authorised staffMedicines must be stored at the appropriate temperature. A record of temperature must be maintained for all areas where medicines are kept (fridge should be monitored daily) Controlled Drugs which are no longer in use should be returned to the pharmacy as soon as possible 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. In particular F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 29 3. OP9 4. 5. 6. OP9 OP9 OP9 Linden House Residential Home 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. OP11 OP15 OP16 OP16 OP26 OP26 OP27 OP28 OP31 OP33 OP34 OP35 OP38 they must be aware of the need to retain medicines for 7 days following the death of a resident. That wishes in respect of dying and death to be recorded. If the resident does not wish to discuss these, a record of this to be in the plan of care. That the components of a meal are pureed separately. That a current and correct copy of the complaints procedure is given to each residents or displayed in their room. That all complaints recorded have details of what action has been taken to resolve the complaint. That the walls of the laundry are cleaned. That there is evidence that the home complies with the Water Supply (Water Fititngs) Regulations 1999. That there is a protocol for managing situations when there is a shortfall in the number of staff required to be on duty. That an action plan is submitted detailing how it will be ensured that 50 of the care satfff will have NVQ 2 or equivalent by 2005. That the Manager is supplied with a copy of the roles and responsibilities for herself and the Area Manager. That the results of surveys undertaken with residents and their relatives are published. That the buisness plan includes details of the finance that will be available to meet the objectives. That the money kept for individual residents is within the amounts covered under the insurance policy. That the servicing date of the standaid hoist is determined and arrangements made for this to be done. Linden House Residential Home F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 30 Commission for Social Care Inspection 1st Floor, Unit 4 Petre Road, Clayton-Le-Moors Accrington Lancashire. 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 F57 F07 S22493 Linden House V228471 310505 Stage 4.doc Version 1.30 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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