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Inspection on 22/09/05 for Linford Park Nursing Home

Also see our care home review for Linford Park Nursing Home for more information

This inspection was carried out on 22nd 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staff working in the home treat the residents with respect and are kind to them. This was confirmed by comments made in many of the quality assurance questionnaires seen by the inspectors. Positive reactions from the residents were noted when interacting with care staff. The care staff support the residents to make choices about their daily lives. The home ensures that residents` clothes are well cared for by designated laundry staff. The laundry area is well organised and was found to be clean and tidy throughout the inspection.

What has improved since the last inspection?

The general cleanliness of the home has improved and the number of domestic staff employed has been increased. New curtains and carpets have put in place in many rooms and communal areas throughout the home. Requirements have been made previously about the lack of staff training. There has been some progress in implementing a programme of training. Staff spoken to confirmed that they had received training for the protection of vulnerable adults, and were able to demonstrate their awareness of the reporting procedure.

What the care home could do better:

All the care plans have to be reviewed and where necessary re-formatted to reflect the individual needs of the resident. Risk assessments need to reflect the actions to be taken to manage and minimise identified risks. All hand written records must be clearly written and accurate. Duplication of records has to be minimised and records must be accurate to ensure that staff providing care have an up to date plan of care to follow. Staff recruitment records have to be reviewed. All the records examined by the inspectors were found to be incomplete with much of the information needed about previous employment omitted or inaccurate. Appropriate police checks must be undertaken together with checks of the Protection of Vulnerable Adults (POVA) register before staff had commenced employment. References must be valid. Records of recruitment interviews should be kept. Fire safety records must be up to date and provide evidence of staff training and testing of fire safety equipment and systems. . Requirements and recommendations have been made at the end of this report, which the home must address within the stated time scales.

CARE HOMES FOR OLDER PEOPLE Linford Nursing Home Linford Road Linford Ringwood Hampshire BH24 3HX Lead Inspector Sue Maynard, Annie Billings Unannounced Inspection 13:00 22 23 & 26th September 2005 nd rd 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 Linford Nursing Home DS0000011430.V251793.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. Linford Nursing Home DS0000011430.V251793.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Linford Nursing Home Address Linford Road Linford Ringwood Hampshire BH24 3HX 01425 471305 01425 471306 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) Northdown Estates Limited Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50), Physical disability (10), Physical disability of places over 65 years of age (50) Linford Nursing Home DS0000011430.V251793.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of 10 beds may be used at anyone time for service users in the PD category, who are between 60 and 64 years of age 19 December 2004 Date of last inspection Brief Description of the Service: Linford is part of a larger building complex, originally a small hospital. The home is situated in a rural area of the New Forest, around three miles from the market town of Ringwood. The home is registered to accept up to 50 service users with a physical disability or care needs relating to old age. Accommodation is offered over two floors, a passenger lift is provided. Linford Nursing Home DS0000011430.V251793.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 the first to be undertaken in the current inspection year 2005/2006. The inspection took place over three days lasting a total of twenty-four hours. Since the last inspection in December 2004, visits have been made to the home in March, May, July and August 2005 to monitor specific standards against which repeated requirements have been made. Enforcement action was considered as the home has failed to comply with the requirements but following the last visit in August 2005 some of the requirements had been partially met. During the inspection the inspectors toured the building and spoke with residents and members of staff. The inspectors found that many of the staff members were reluctant to speak with them. The staff would not give any reason. The managing director for the home was present throughout the inspection and accompanied the inspectors on their tour of the building. The inspectors noted that the general environment of the home and the standard of cleanliness in all areas had improved. What the service does well: What has improved since the last inspection? The general cleanliness of the home has improved and the number of domestic staff employed has been increased. New curtains and carpets have put in place in many rooms and communal areas throughout the home. Requirements have been made previously about the lack of staff training. There has been some progress in implementing a programme of training. Staff spoken to confirmed that they had received training for the protection of vulnerable adults, and were able to demonstrate their awareness of the reporting procedure. Linford Nursing Home DS0000011430.V251793.R01.S.doc Version 5.0 Page 6 What they could do better: 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. Linford Nursing Home DS0000011430.V251793.R01.S.doc Version 5.0 Page 7 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 Linford Nursing Home DS0000011430.V251793.R01.S.doc Version 5.0 Page 8 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): Standard 3 was not assessed at this inspection. Standard 6 is not applicable to this home. EVIDENCE: Linford Nursing Home DS0000011430.V251793.R01.S.doc Version 5.0 Page 9 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 and 10 The care plans do not reflect the individual health, personal and social needs of the residents to ensure that their personal needs are met. Appropriate interaction with staff ensures that the residents’ privacy and dignity are maintained. EVIDENCE: The inspectors examined samples of records for four residents. Although there has been some improvement in the formatting of the care plans, evidence of duplication of information was found by the inspectors. The care plans are still not personalised and remain as “core plans”. This has been discussed at previous visits to the home in March, May, July and August 2005, with both the acting matron and the managing director, insufficient progress has been made to address the points raised. Issues about care planning were also discussed with the owners of the home during a meeting at the commissions’ office in April 2005. Many of the care plans give contradictory information. A care plan for one resident identified that two staff were required to assist with mobilisation and transfer from bed to chair. There was no mention of the Linford Nursing Home DS0000011430.V251793.R01.S.doc Version 5.0 Page 10 use of a hoist. In a second care plan, not related to mobilisation, the plan referred to the use of a hoist for all transfers. This conflicting information does not provide staff with clear guidance about the specific care needs of the resident which may result in the resident being transferred inappropriately. A care plan that referred to wound care, provided conflicting information about the type of dressing to be used and how often the dressing was to be checked and changed. The evaluation updates referred to the instructions from the tissue viability specialist nurse. The inspectors were unable to ascertain the name of this nurse and when she last visited to re-assess the wound. This was discussed with the acting matron and the owner of the home. No satisfactory reasons were given and the evidence that the specialist nurse had visited could not be found. There was evidence that the families of the residents have been included in the drawing up of the care plans and they had signed to say that they agreed with the actions to be taken. All the care plans seen by the inspectors provided evidence that the plans had been updated monthly. Two care plans had been updated within a shorter time reflecting the changes in the condition the resident. The re-evaluations of risk assessments did not always appear to be appropriate. Risk assessments identified areas of high risk but there were no action plans in place to state how the risk was to be managed. A resident was identified as being at risk from falling and the care plan stated that the resident was also known to wander. The assessment stated that the resident was to be supervised at all times. The inspectors observed this resident wandering about communal lounge areas and corridors unsupervised. No staff members were nearby on each occasion. A care plan identified the day/s “that the resident will have a shower or bath on a Tuesday”. The inspectors were only able to identify one occasion in the daily care records of the previous weeks that the resident had been showered. The residents’ records provided evidence that other health care professionals had been consulted and had visited the home. The inspectors were aware that the family of one resident had asked for an occupational therapist to assess the appropriateness of armchair used by the resident in February 2005. There was evidence in the records that this had been brought to the attention of the GP but there was no record that this assessment had been undertaken. However, the owner of the home advised the inspectors that following a requirement made from a previous monitoring visit to the home, which asked for an assessment the appropriateness of all the armchairs in use in the home to be made by an occupational therapist, letters have been sent to the GP’s of the residents. The inspectors noted that the care assistants make daily entries in the residents’ records of the events and care given by them. These records were found to be clear and concise. The trained staff were also writing a daily report which in many instances duplicates what has already been written. This was discussed with the acting matron and the managing director of the home and they agreed to review this area of record keeping. Poor hand writing in some of the records made by the trained nurses made reading the entries in the care Linford Nursing Home DS0000011430.V251793.R01.S.doc Version 5.0 Page 11 plans and daily reports very difficult. All staff must be aware that all entries made in residents’ records should be clear, concise and ledigible. The home is reminded that all record keeping should follow the statutory guidelines laid down by the Nursing and Midwifery Council for accurate record keeping. Many of the residents’ bedrooms contained fluid intake and output charts. It was noted that fluids had been charted as having been given at a time in advance of the actual time that the inspectors examined the charts. There were large time gaps between recorded entries. A correct fluid balance could not be measured as there were no accurate output entries, just a tick or “incontinent”. Inaccurate entries on the charts do not make it possible to provide an accurate hydration assessment of the residents. The inspectors spoke with many of the residents. They all confirmed that the staff in the home is “attentive, kind and considerate”. The residents were asked if the staff responded promptly to nurse call bells. They reported this varied at different times during the day but generally they did not have to wait too long during the day but that the night staff always took longer to respond. The residents also confirmed that the staff respect their privacy and dignity. The inspectors witnessed staff knocking on bedroom doors before entering and speaking appropriately and respectfully to the residents. Linford Nursing Home DS0000011430.V251793.R01.S.doc Version 5.0 Page 12 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): None of these standards were assessed at this inspection. EVIDENCE: Linford Nursing Home DS0000011430.V251793.R01.S.doc Version 5.0 Page 13 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 Accurate records of complaints made to the home are not maintained to provide evidence that complaints are acted on appropriately. The vulnerable adults procedure and staff training ensures that any allegation of abuse will be addressed appropriately. EVIDENCE: The home has a complaints procedure that is given to the families of the residents on admission to the home. The inspectors found that some information about contact details for Social Services had been omitted and the name of the Commission for Social Care Inspection had not been changed from the National Care Standards Commission. These errors were brought to the attention of the owner of the home who agreed to revise the document and make the necessary changes. Issues about the home’s complaints procedure and the maintenance of a complaints log were raised in the report of December 19th 2004. A requirement made in that report has not been met. The inspectors asked to see the complaints log for the home. No documentary evidence of complaints could be supplied. The owner of the home stated that no complaints had been made to the home. This information did not correspond to evidence seen by the inspectors in quality assurance questionnaires completed by relatives of the residents in the home. Two questionnaires stated that complaints had been made to the home and these Linford Nursing Home DS0000011430.V251793.R01.S.doc Version 5.0 Page 14 had been addressed satisfactorily. The owner of the home stated that she was not aware of these complaints. The inspectors advised that a record of any issues or complaints raised by residents, their families or staff must be kept and must be available for inspection at any time. Residents spoken to by the inspectors confirmed that were aware of who they should speak to in the event that they had a complaint about their care or any other issues that concerned them. Staff spoken to by the inspectors were able to demonstrate that they were aware of the procedure to be followed when reporting an incident of abuse. They were aware of the categories of abuse and confirmed that they had received training for abuse awareness. The inspectors saw evidence of training that had been given to the staff. Two training sessions have taken place in the home, in August and September 2005, provided by the Alzheimers Society. Certificates of attendance have not yet been provided to the home. Linford Nursing Home DS0000011430.V251793.R01.S.doc Version 5.0 Page 15 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 programme of maintenance and cleaning now in place in the home ensures that the residents live in a clean and well maintained environment. EVIDENCE: The inspectors, accompanied by the owner of the home, undertook a full tour of Linford 1&2 on the first day of the inspection. Some minor defects were identified and were noted by the owner of the home but overall the inspectors found the standard of cleanliness and decoration of this part of the home improved. There was evidence that many of the bedrooms and communal areas had been redecorated and new carpets and curtains supplied. The owner of the home explained that as part of the programme of maintenance, empty rooms have been redecorated. Damaged armchairs seen on previous visits to the home have been removed. In one area of the unit there was evidence of water damage to walls and floors due to a leaking water tank, which had also interrupted the supply of hot water to some rooms. There were no residents in these rooms and the managing Linford Nursing Home DS0000011430.V251793.R01.S.doc Version 5.0 Page 16 director of the home explained that contractors were due to visit the home on Monday 26th September to repair and replace the tanks. She also confirmed that all the damaged carpets and paintwork would be rectified. The inspectors left the home at 13.30 on Monday 26th September and at that time there was no evidence that the contractors were working in the building. Many damaged window catches were brought to the attention of the managing director who spoke with the person responsible for maintenance in the home. Many of these catches had been replaced by the end of the inspection on Monday 26th September. The inspectors noted that a refrigerator in the breakfast preparation area on the ground floor was badly damaged. The managing director had provided a new refrigerator by the time the inspectors returned on the third day of the inspection. The managing director of the home gave instructions that other minor defects noted around the building would be rectified as soon as possible. Further tours of the building by the inspectors on the second and third days of the inspection confirmed that many of the repairs had been undertaken. One empty bedroom was found to be full of old equipment and some stationary supplies. There were many empty cupboard boxes in this room, which presented as a fire hazard. This was also brought to the attention of the managing director. This room was completely cleared by the time the inspection was completed. Unpleasant odours were noted in two bedrooms by the inspectors and the managing director of the home who stated that she would instruct the domestic staff to clean the carpets to see if the odours could be dispersed. The home has employed additional domestic staff and this is reflected in the higher standard of cleanliness throughout Linford 1&2. This was noted especially by the inspectors when they entered the home unannounced at 06.45 on the last day of the inspection. All areas were found to be tidy. Sluice areas were clean and no offensive odours were noted in these areas or any of the bedrooms. The laundry areas were found to be very tidy. No soiled linen was found on the floor. Three new washing machines have been installed since the last inspection. The lint filters of the dryers are cleaned hourly and the staff member responsible for the laundry signs to state this has been done. Cleaning materials were stored in a locked cupboard. All clean clothing had been ironed where necessary and each resident has a marked basket in which small items of clothing are stored prior to it being taken to their room. Larger items such as shirts and dresses were seen hanging on rails to prevent creasing. The inspectors did note that there were many pairs of socks that were unmarked. The owner of the home explained that relatives do not always mark items of clothing in spite of being asked to do so and this leads to the laundry staff being unable to identify the owner. Linford Nursing Home DS0000011430.V251793.R01.S.doc Version 5.0 Page 17 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 Consideration is not given to the appropriate deployment of staff during certain periods of the day to ensure the safety of the residents. Failure to ensure that staff recruitment procedure is adhered to puts all the residents in the home at risk. The lack of a formal programme does not enable staff training to be effectively monitored. EVIDENCE: The inspectors saw copies of the staff rotas covering the period from 19th September- 16th October 2005. At this time there is only one full time RGN covering Linford 1&2. The managing director of the home confirmed that she is actively seeking to employ more trained staff. The RGN for this part of the home also has the responsibility as acting matron in the absence of a registered manager for the home. The rotas provided evidence of the care staff on duty. Many of the staff are working in excess of 48 hours a week, some were noted to be working 60 hours and on occasions 72 hours. In some staff records the inspectors noted that not all staff had signed to say they were prepared to work in excess of 48 hours a week. Linford Nursing Home DS0000011430.V251793.R01.S.doc Version 5.0 Page 18 The inspectors found difficulty in ascertaining exactly who was on duty as members of staff do not have identification badges. Staffing rotas do not state the full name of each staff member, giving only a first name. During the first day of the inspection the inspectors identified a lack of staff to supervise residents in the main dining room. A resident has been left alone seated in a wheel chair at one of the tables. As she attempted to stand up pressure on the footplate of her wheel chair caused it to tip. The resident would have fallen but for the prompt action of the managing director of the home and one of the inspectors. A member staff must be available in communal areas to ensure the safety of the residents. All the staff in this area of the home work 12 hour shifts. Long shifts especially for trained staff, brings into question whether safe practice, especially for the administration of drugs, can be undertaken and maintained at all times. The owner of the home confirmed that members of staff are undertaking NVQ training at both level 2 and 3. An external training company is providing the training. The company has confirmed that six staff members are undertaking level 2 and two at level 3. The inspectors examined staff recruitment records. These were found to be incomplete. The validity of some references could not be established. Many of the references appeared to be photocopied. Dates had been changed or removed with use of correction fluid. Dates on some of the references did not correspond with dates of employment stated on the application forms. One reference response was found to be blank but had been signed signature supposedly by the referee, but the was no official hospital stamp to validate the signature of the referee. Many of the records did not provide evidence of current police checks from the Criminal Records Bureau (CRB). A previous employer had undertaken some of the checks that were available. This was brought to the attention of the managing director of the home who stated that she was not aware that new checks had to be undertaken when employing a new staff member. The inspectors advised her that the procedure for applying for CRB checks had been revised in 2004 and that the certificates for staff employed after July 2004 were not valid. Checks from the Protection of Vulnerable Adult (POVA) register had also not been undertaken for some new staff. The owner of the home was reminded that new staff must not commence employment without the POVA and CRB checks being undertaken. Work permits from the Home Office were only seen in some of the records. Only two files contained evidence of interviews being undertaken before offers of employment were made. The owner of the home told the inspectors that a new procedure for the interviewing of potential new staff is now in place. No evidence of this was seen. The inspectors could only find evidence in two files that one of the senior RGN’s for the home, who, in the absence of a Registered manager for the home, is having some responsibility for managing the home. Linford Nursing Home DS0000011430.V251793.R01.S.doc Version 5.0 Page 19 All these shortfalls in the records were brought to the attention of the managing director of the home. The inspectors have advised her that all the recruitment files must be put in order. Requirements have been made following the monitoring visits to the home with regard to training for staff at all levels in the home. Some staff members spoken to by the inspectors were able to confirm that they had recently undertaken training for: Fire safety Safe moving and handling Infection control Understanding dementia Abuse awareness The acting matron has undertaken additional training for: Wound care Continence awareness and catheter care. It was reported to the inspectors that further training of the staff has been arranged and evidence of the topics to be covered was shown to them. The inspectors examined staff training files and were able to confirm that some staff members had undertaken training. However the inspectors were not able to confirm that the new staff members had undertaken appropriate staff induction training. Records of this training were seen in one file only and this had not been completed. The inspectors have advised the managing director of the home that if senior staff in the home provides training then these staff members should attend accredited training courses for trainers. Linford Nursing Home DS0000011430.V251793.R01.S.doc Version 5.0 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 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, 36 and 38 The absence of a registered manager and lack of sufficient management input means that the provider cannot demonstrate that the home is well run. The use of questionnaires enables residents and their families to express their views about the services that are provided. The system that is currently in place is insufficient to ensure that staff receive adequate supervision. Monitoring of some systems to ensure the health and safety of residents and staff are inadequate and puts them at risk. EVIDENCE: The home does not have a registered manager in post at this time. Linford Nursing Home DS0000011430.V251793.R01.S.doc Version 5.0 Page 21 The managing director of the home confirmed that she is actively seeking to recruit a manager. A senior Registered nurse is currently responsible for the management of the home. At this time she is also the only trained nurse on the staff rota for Linford 1&2. The home has recently undertaken a survey of the care provided in the home in the form of a questionnaire sent to the relatives of the residents. The feed back form these were generally positive and comments highlighted the caring and friendly attitude of the staff. Family members commented that they were always made to feel welcome and described the staff as understanding and communicative. They also commented that the home was always clean and the staff appeared to do their job efficiently. Some negative comments made included, residents had a lack of appropriate stimulation. One family complained that their relative had been moved to another room without prior consultation with them. Two families stated that they had made complaints to the home about different issues but that these had been dealt with appropriately and they were satisfied with the outcome. The inspectors were not able to establish if any actions had been taken to address the negative comments and the managing director of the home was advised to audit the questionnaires to enable her to be aware of any shortfalls in their services can be identified. The managing director of the home stated that she would compiling further surveys and would ensure that these results would be looked at closely and action taken to address any negative comments. It was reported to the inspectors that surveys are undertaken with the residents and are completed by the activities co-ordinator. The managing director of the home has been advised to find a more impartial method of completing the surveys possibly involving the residents’ families. It was also suggested that surveys were also sent out to GP’s and other health professionals who may visit the home. Although Standard 36 is not a key standard, but during the examination of staff records the inspectors saw records marked as staff supervision. The inspectors spoke to the acting matron about staff supervision and how she viewed this as part of the general maintaining of care for the residents. She explained to the inspectors how she thought supervision should be structured. The records seen by the inspectors provided evidence that the supervision time had been used purely as a training session. There was no structured plan in place to ensure that the staff receive proper regular supervision. This was discussed with the acting matron and the owner of the home, who said that they both wish to undertake supervision of staff appropriately. The inspectors advised them that training for supervision is available and both should attend before undertaking any further staff supervision. They confirmed that they would make enquiries about where this training can be accessed. Linford Nursing Home DS0000011430.V251793.R01.S.doc Version 5.0 Page 22 The inspectors examined samples of maintenance and service records for equipment used in the home. Generally these were found to be up to date and accurate. Fire safety records and staff fire training records were examined. There were requirements made following the visit from the Hampshire fire safety officer. Initially the inspectors were unable to establish whether the requirements had been met, as the records were stored in several different files. The fire safety training and regular drills as required are now taking place and emergency lighting is being tested. The inspectors have advised that all records relating to fire safety training and records of maintenance and testing of fire safety equipment be kept together in one file rather than several. Some records of staff attendance of fire safety training were provided but these did not provide evidence that all the staff employed in the home had attended the training provided. At this time staff have not received first aid training or food handling and hygiene training. Health and safety training including COSHH is not provided. There was evidence that some staff have undertaken infection control training but the certificates issued are not dated. The inspectors asked to see evidence that safety testing of electrical appliances had been undertaken. The maintenance person produced lists of appliances that he reported had been tested but there was no evidence of dates of this testing on the appliances. The kitchen was found to be very clean and tidy. The food store for dry foodstuffs was also very clean and tidy. Fridges and freezers were examined. One was noted to be out of order and the inspectors were informed that this was being replaced. In one fridge the inspectors noted that a packet of ham had been opened but the date of opening was not recorded. This was being stored next to an open packet of red meat, which again was not dated. This was brought to the attention of the owner of the home who stated she would speak with the cook and ask her to deal with this. Samples of menus were seen. Residents confirmed that they had a choice of food but could not always remember what they had ordered. The inspectors noted that the residents had been offered chips with their meal for supper two evenings running. Residents spoken to did not appear unduly concerned as they confirmed they could have sandwiches or another alternative if they wished. The inspectors noted that lists of the residents’ food preferences for breakfast are available in the breakfast preparation areas on each floor of Linford 1&2. This also lists the residents’ preferred hot drink in the evening. This list is displayed appropriately. Linford Nursing Home DS0000011430.V251793.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 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X X 2 X 1 Linford Nursing Home DS0000011430.V251793.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 OP 7.2 Regulation 15(1) Requirement You are required to ensure that all plans of care contain information that is correct and is relevant to each individual service user. Any action plans that are formulated must specify a time scale and review date and there must be evidence that a review has taken place within this stated timescale. Core care plans should only be used as a framework on which a more detailed plan of care is formulated. This is a repeated requirement from inspections of 19th December 2004. 30th March. 17th May 2005.15th July2005. 30th August 2005. A statutory requirement notice has been issued in respect of this requirement. You are required to maintain a record of all complaints made to the home. This record must document by whom the complaint was made, who will deal with them and an assurance that the complaint will be DS0000011430.V251793.R01.S.doc Timescale for action 12/12/05 2 OP 16.3 17(2) Schedule 4(11) 12/12/05 Linford Nursing Home Version 5.0 Page 25 responded to within a maximum of twenty-eight days. This requirement was previously made in the report of December 19th 2004. A statutory requirement notice has been issued in respect of this requirement. 18(1)(a) The registered person must ensure that staff are deployed throughout the home in sufficient numbers to safeguard the safety of the residents. Regulation The home must provide a staff 17(2) rota that records the full names Schedule of each member of staff and the 4(7) hours that they have worked over a twenty-four hour period. Schedule The registered person must not 2 allow a person to work in the Regulation home unless the employer is 7,9, satisfied as to the authenticity of 19(4)(c) the two written references supplied. Gaps in employment history must be explored. Schedule You are required to obtain two 2 written references for all new Regulation members of staff prior to 7(a),9,19 commencing employment. And checks must be undertaken with the home Criminal records Bureau and the Protection of Vulnerable Adults register prior to staff taking up employment This requirement was previously made in the report of March 30th 2005 23(4) You are required to maintain accurate and up to date records of the testing of fire safety equipment and records of staff attendance at fire safety training. Signatures of staff must be obtained to confirm their attendance at the training. This requirement was Linford Nursing Home DS0000011430.V251793.R01.S.doc Version 5.0 Page 26 3 OP 27.1 12/12/05 4 OP 27.2 12/12/05 5 OP 29.2 12/12/05 6 OP 29.3 12/12/05 7 OP 38.2 12/12/05 8 OP 38.2 13(4) 9 10 OP 38.2 OP 36 16(2)(g)(j ) 18(2) previously made in the report of 13th July 2004. 19th December 2004. 30th March 2005. A statutory requirement notice has been issued in respect of this requirement The registered person must 12/12/05 make suitable arrangements for staff to undertake training in first aid. Staff must receive regular 12/12/05 training for the safe handling of food served in the home. The registered person must 12/12/05 ensure that all staff working in the home receive formal supervision at least six times a year. 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 5 Refer to Standard OP 7 OP 7 OP 7 OP 29 OP 30 Good Practice Recommendations All records should be accurate and written clearly and in a format that can be understood by all those who refer to them The registered nurse auditing and counter signing entries made by the health care staff should reduce duplication of daily records. Entries made on residents’ fluid charts should be accurate and reflect the correct time and amount that have been administered. Output should be accurately recorded. An accurate record of any recruitment interviews undertaken should be kept. There should be evidence that gaps in employment history have been explored. An individual record of training undertaken by each staff member should be kept. Linford Nursing Home DS0000011430.V251793.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Linford Nursing Home DS0000011430.V251793.R01.S.doc Version 5.0 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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