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Inspection on 24/04/07 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 24th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

The pre admission assessment is good and the service users are assessed prior to moving into the service. This ensures that the home can meet their needs. Improvement in the care planning continues, this included records of GP visits that recorded any change in the treatment of the service users. Positive comments were received about the attitude of staff. Service users meetings have been implemented as part of seeking the views of the service users. The home has a pictorial menu that staff used to help the service users in choosing from the menus.

What has improved since the last inspection?

A record of medication administered to the service users was available. A record of monthly visits as undertaken by the provider was maintained at the service.

CARE HOMES FOR OLDER PEOPLE Linford Park Nursing Home Linford Road Linford Ringwood Hampshire BH24 3HX Lead Inspector Anita Tengnah Unannounced Inspection 24th April 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Linford Park 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 To Be Confirmed Care Home 107 Category(ies) of Dementia (12), Dementia - over 65 years of age registration, with number (64), Old age, not falling within any other of places category (80), Physical disability (10), Physical disability over 65 years of age (80) Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. All service users must be over the age of 60. A maximum of 80 service users can be accommodated. This is subject to review on or after 21st August 2006. 22/08/06 Date of last inspection Brief Description of the Service: Linford Park nursing home is situated in Linford, a rural area of the New Forest, around three miles from the market town of Ringwood. The home is registered to accept up to 107 service users over 60 years of age. There is currently a condition that only allows up to 80 service users to be admitted. The home is registered to provide care to people in the older person category with mental health needs, dementia, and physical disability. Accommodation is offered over two floors, a passenger lift is provided. The current fee charged is £442-£750 Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A fieldwork visit was undertaken over a day on the 24th April 2007. The process included a tour of the service when a number of the bedrooms, communal areas, and bathrooms were viewed. Staff practices were observed; service users and staff records were examined. As part of case tracking a number of the service users, staff, two visitors, and two visiting professionals were spoken with and their views sought. There were 53 service users accommodated at the time of the visit. Information gained from the pre inspection questionnaire was also used and included in this report, as was information gathered by the commission since the last inspection to contribute in assessing judgements in this report. A random visit was carried out in August 2006 that indicated that there had been improvement in the care planning and appointment of a manager. There were two requirements made at the last visit these were looked at as part of this inspection. The home does not have a registered manager at the time of this visit since the manager left in October 2006. What the service does well: The pre admission assessment is good and the service users are assessed prior to moving into the service. This ensures that the home can meet their needs. Improvement in the care planning continues, this included records of GP visits that recorded any change in the treatment of the service users. Positive comments were received about the attitude of staff. Service users meetings have been implemented as part of seeking the views of the service users. The home has a pictorial menu that staff used to help the service users in choosing from the menus. Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The management of substances that are hazardous to health was not managed appropriately is to the detriment of the service users. The provider was asked to take immediate actions to remedy this at the time of the visit. Some staff practices observed did not always respect the dignity and well being of the service users. The management of the service users’ medication was poor and put them at risk. A record of all complaints received and action taken in response to these must be maintained, as this was not available. The health and safety of the service users must be promoted and ensuring that wheelchairs are fitted with foot rests as required. A review of the excessive hours worked by staff must be undertaken as this put the service users at risks. There must be adequate trained staff at the home at all times to meet the assessed needs of the service users. Please contact the provider for advice of actions taken in response to this Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides information to the prospective service users so they can make an informed choice. Some of the information was not current. There is a good pre-admission assessment process in place. EVIDENCE: The home has a statement of purpose that the acting manager said is made available to the prospective service users. This was found to be detailed and included a complaint procedure. A review of the statement of purpose is Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 10 needed to reflect the current staffing and management provision at the service. The certificate of registration was displayed. This indicated that there is a condition of registration that the home can admit up to 80 service users. The care records of two recently admitted service users were looked at as part of case tracking. A pre admission assessment of needs was carried out for one of the service users. Staff reported that this information is used to formulate their initial care plans on admission. There was no pre assessment for the other service user as the acting manager reported that this was an emergency admission and a full assessment was carried out on admission and care plans formulated. The assessments of needs included dietary needs, manual handling, mobility, continence, life history and medication. The acting manager confirmed that the service did not provide intermediate care. Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 7,8,9,10 The care plans had improved and staff were clear about the support that the service users required with their care. The health care needs and access to external agencies are well managed. There has been some improvement in the recording of medication given. However some aspects of the medication management were poor and detrimental to the service users’ safety and well being. Staff treated the service users with respect and interacted well with them. EVIDENCE: Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 12 The care plans of 4 service users were seen as part of this visit to look at how the home plans to meet the needs of the service users. There has been marked progress sustained with the care planning process. The care plans were detailed and contained information about the assessed needs of the service users and actions required in order to meet them. These included assessments and care plans such as personal care, manual handling, dietary needs, continence, medication, and psychological needs. There was evidence in some of the care plans that the service users had been involved in their formulation. The care plans were reviewed at regular intervals in order to reflect any change in the needs of the service users. Risk assessments were available for three of the service users requiring bed rails but missing in one care plan. It was noted that not all the service users had bumpers for bedrails. This was brought to the attention of the nurse in charge who said that all of the beds with bedrails must have them in place. Staff must ensure that consent for the use of bedrails is also sought as this was missing in one of the care plans. All the service users are registered with the local surgery. The acting manager reported that the home had good relationship with the local primary care trust and the service users were supported to access health care services as required. The home has the service of two local GP practices. Staff reported that they undertook regular visits. One had twice weekly and the other held weekly surgeries at the home. There were good records maintained following visit/ review of the service users by the GPS. The service users were supported to access other services in the community. One of them was attending a dental appointment in the community with support of a carer. The home has a medication policy and procedure and staff spoken with were aware of these. Following a random visit in August 2006 a repeated requirement was raised that a record of all medications that have been administered to the service user must be kept appropriately. A sample of the Medication Administration Record (MAR) seen at the time of the visit showed that prescribed medications given were recorded appropriately. The manager reported that the registered nurses were responsible for medication management. Two of the service users were selfmedicating at the time of the visit and their records contained consents from the GP. There were some records of medication received at the home but these did not include medication that the service users brought in with them on transfer. A record of all medication brought into the home must be maintained to include date of receipt, quantity received and the signature of staff receiving the medicines. Further advice can be found in the Royal Pharmaceutical Guidance. It was noted that one of the service users was prescribed a medication with different dosages to be administered over a period of two months. It would be Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 13 considered an element of good practice that varying dosages should be prescribed separately to avoid risk of errors. Another service user’s MAR sheet showed that he had been administered pain killers however there was no record of this medication having been dispensed for him. The service user had another medication bottle that was handwritten with his name and the name of the drug. There was no record of this medication having been dispensed or received for him. These were brought to the attention of the acting manager and nurse in charge, medicines must only be administered to the person for whom they have been supplied, labelled and prescribed. The practice of decanting medication puts the service users at risks. In order for staff can administer medicine it must have a printed label containing the service users’ name, date of dispensing, name and the strength of the medicine and the dosage and frequency of administration. Some of the aspects of medication management at the home were poor and detrimental to the service users’ safety. A number of the service users were spoken with and practice observed as a high proportion of the people living at the home have dementia and could not contribute to the inspection process. Three service users said that they were happy and “ the home was all right”. Two of them said they preferred to remain in their rooms and joined others for lunch and staff respected this. Another service user talked about her room that she liked with her “things around including flowers from her daughters.” Two of the staff were observed to interact well with the service users and were attentive when dealing with them. Staff were observed to knock prior to entering the service users bedrooms. Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 12,13,14,15 The social and recreational facilities for the service users are satisfactory and would benefit from further development and staffing to meet all the needs of the service users. The service users are supported to maintain links with the community and their family and friends. Some of the service users exercised choice and care plans should reflect how this is achieved for others. The meals are satisfactory and meet with the satisfaction of most of the people, but the processes for ensuring people get their preferred option in good time are not always robust. EVIDENCE: Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 15 An activity programme was displayed in the dining room and leaflets were also available. Activities offered included quiz and games and music, followed by tea. The home had only one activity coordinator at present as the other is on sick leave. Staff reported that this had impacted on the activities for the service users due to the size and layout of the home. The activity coordinator said that she visited the service users in the morning and helped them with their menus. Two of the service users were observed making knitted teddy bears and one service user talked about the knitting that she said she enjoyed. There are no planned activities at the weekends as staff said there are activity coordinators. Staff reported that they played games or chatted to the service users depending on when they had the time. Comments from the service users meeting indicated that they enjoyed the activities and suggested trying some past activities such as noughts and crosses and music/exercise. Further development in the activity programme would benefit the service users. There were a number of service users who were either wandering or asleep in their chairs for long periods of time and at different times of the day and with no interaction. Comments received indicated that they would like more activities. Comments included “the minibus to be repaired and operative by the summer, nothing seems to have happened”. The home has an open visiting policy and it was evident from the record of visitors as kept by the home that there was no restriction on visiting. Comments received and three service users confirmed that they have autonomy to receive their visitors in private. Two visitors spoken with at the time of the visit said that they visited regularly and were “ made welcome”. It was evident from interaction observed that the some of the staff had developed good relationship with the relatives. Three of the service users spoken with said that they chose when they went to bed and got up. However the majority of the service users cannot make that choice. The staff reported that the night staff gave the service users who required feeding their breakfasts and medication. It was difficult to ascertain what autonomy these people did have. This was discussed with staff, as the night care plans could be further developed to indicate the choices offered and reflect their waking habits for example. The home has a planned menu and a copy of the week’s menu was available in the dining room. Comments received from 6 of the service users were that meals were “all right “ to “good and wholesome”. Lunchtime meal was observed and this appeared wholesome and balanced. Staff were observed to offer a choice of drinks to the service users at lunchtime. Three staff were available in the dining room and offered the service users support with their meals. Staff stated that the service users had the menu in a pictorial format to help them in choosing from the menus. A service user said that she did not Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 16 enjoy her lunch on the day of the visit. She had ordered an omelette but was given what appeared like “scrambled egg” and said that this was not cooked properly. Other comments were that “you cannot go by the menu” and this was an issue that was also raised at the service users’ recent meeting. The dessert served at lunchtime on the day of the visit was also different to the planned menu. The chef said that she had changed it, as the weather was cooler, however the service users were not aware of the change. It was noted that at lunchtime a carer had two of the service users’ meals that included main course and puddings on one tray. She went and fed one service user then proceeded on to the next room with the dirty dishes on the tray to feed the next one. This was brought to the attention of the acting manager, as the practice did not respect the dignity of the service users. The meal would also be cold and may pose infection control risk. The acting manager confirmed that the meal was not warm and that the problem of the service users receiving cold meals had been previously raised with staff. Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 16,18 The service users and their relatives are confident in approaching staff with their complaints. However there is no record of complaints received and action taken. Staff were clear about reporting any allegation of abuse. EVIDENCE: The home has a complaint procedure in place that indicated that the manager would deal with all complaints. However the acting manager said that himself or the administrator depending on the type of complaint would deal with complaints received. A visitor spoken with said that concerns /complaints she recently raised with the acting manager had been dealt with promptly. Discussions with staff members indicated that they were unaware of the process of recording any complaints received. At the random visit in August 2006 social services had received complaints about the home that were brought to the attention of the home manager and these were not recorded in the complaint log. The manager had agreed that he would include complaints received by social services and the commission. Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 18 The complaints logbook was looked at as part of this visit. There were no entries in this book. The acting manager discussed a few recent complaints/ concerns that he had dealt with, however none of these were recorded in the log. A service user spoke about recent concerns/ complaints that were raised with the acting manager and had been dealt with. Comments received indicated that 3 of the service users said that “usually” they know who to speak to if they are unhappy. Other comments included that “ Depends who is on duty”. Another comment received was ”complaint made but had no feedback”. The record of complaints received remains inadequate. Staff appeared to be unclear about who is responsible for the complaint management at the home. The acting manager said that he would deal with “clinical” issues and the rest would be left to the administration manager. The complaint procedure must be reviewed to reflect the timescale that written complaints would be responded to; as there is conflicting information that suggests this could be 2 or 7 days. The provider must ensure that there is a record of all complaints received at the service and record of the investigation and any action taken. It was not possible to say how many complaints have been received since the last inspection. The adult protection procedure was in place and included the Hampshire interagency procedure. Staff spoken with stated that they would approach the manager if there were any allegation of abuse. Some of the staff have completed training in adult protection and the manager reported that further training is planned for new staff. Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 19,26 The home provides the service users with a clean and comfortable accommodation. Screening in shared rooms does not provide adequate privacy. The infection control procedures at the home are satisfactory. EVIDENCE: A tour of the premises was undertaken as part of this visit. A number of the bedrooms were seen and the service users’ views sought. The home was clean and staff reported that there is a programme of renovation in place. Comments received indicated that the home is “usually clean”. Some of the bedrooms were personalised comments received were that “ this is not too bad a place”. Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 20 Another service user said that her family ensured that she has “a comfortable room” as she spent a lot of time in her room. Two of the bedrooms were rather bare and not homely. Staff reported that these service users did not have a lot of visitors, and that the carers should be assisting the service users in personalising their rooms. The home has a number of shared rooms. One of the shared rooms seen was fitted with curtains, however this did not provide adequate privacy for the service user as the screen did not go round the bed as required. This was brought to the attention of the nurse in charge and must be rectified before a second person is admitted to this room in order to maintain the privacy and dignity of the service users. At the time of the visit this bedroom was accommodating only one service user, as the other bed was vacant. Comments from the service users included “accommodation reasonable”. Another comment from a relative was that he visited at different times and the home “was always spotless”. Some parts of the home were in poor state of repair with worn and stained carpets. Due to the low occupancy there were no service users in that part of the building. The paintwork in the corridors was in need of attention, staff reported that this had been identified and would be renewed as part of the ongoing work. The home has a laundry where all the service users’ laundry was undertaken internally. The washing machines were fitted with a sluicing programme and appropriate for the needs of the service users. The laundry room was well organised and in a good state of repair. Flooring was impermeable, a sink was provided and equipment such as gloves and aprons were available. Staff spoken with said that the laundry worked well and the carers followed the home’s procedures for soiled/infected linen. Two comments cards raised concerns about the service users’ clothing going “missing”. The acting manager said that this was an ongoing problem that the staff had been reminded to check the labels and ensure that all the service users clothing is appropriately labelled. A random check showed that the clothing in the laundry room was labelled with the service users’ name. Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 27,28,29,30 The staffing numbers are only adequate to meet the present needs of the service users, and some staff are working excessive hours. The recruitment process is not robust and does not protect service users. Some staff were employed prior to receiving full disclosure. There is an ongoing training programme that supports the staff in their practices. EVIDENCE: The home has a duty roster for carers and a separate roster for the ancillary staff. The home is staffed and managed as two wings known as Linford and Woodlands. A sample of the duty roster showed that there were 1 trained and 4 carers in Linford and 1 trained and 5 carers on Woodlands on day duty. Night duty had 1 trained staff and 2 carers in Linford and 1 trained staff and 3 carers in Woodlands. Both of these wings are spread over two floors. At the random visit in August 06 staff members working in the Woodlands wing of the care home raised concerns about staffing levels. This wing cares for Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 22 persons suffering from dementia and some service users could present challenging behaviours. Staff had reported that the provider had reduced the qualified nurse ratio on the day shift from two nurses to one nurse. The staff were concerned that the reduction of trained nurses and increase in the number of the service users could adversely affect their welfare. The manager and nurses working had reported that they would monitor the effect that the staffing numbers had on the service users. The trained staff number has not changed and it was noted that the acting manager was the nurse in charge on Woodlands and working between 54 and 72 hours per week. The acting manager is also responsible for Linford wing as part of his role. Staff spoken with stated that sometimes “they are stretched” and there are a number of service users in Woodlands with high care needs due to their challenging behaviour. Three service users were observed wandering at lunchtime in Woodlands and the acting manager said that there were two staff on duty as one of them had left at 12 0clock and agreed that this was a busy period for the staff. There is a number of staff who are working excessive long hours and that includes one staff member who is on the night duty roster to work 12 nights in a row totalling 144 hours. A response from the provider indicated that this had been a typing error and the staff had worked 9 nights instead of 12. The provider must ensure that the home has adequate staff to meet the needs of the service users at all times. The excessive hours worked by some staff must be reviewed as this can be to the detriment of the service users. It was evident from interaction observed that the staff had developed good relationships with the service users and their families. Comments were “the staff are very good and helpful”. Another comment was “the senior staff always do their best” and “ the good natured and cheerful attitude of all staff leaves little to be desired”. A sample of four staff records was looked at as part of this visit. All applicants had completed an application form and provided references. The acting manager interviewed all the applicants and records of interviews were maintained. Two of the staff had evidence of Criminal Record Bureau (CRB) checks and POVA first checks been completed prior to employment. However two of the carers had POVA first checks but no CRB checks had been received. Both of them had been in employment since January 07.The acting manager said that these staff had been employed through a recruitment agency. The acting manager is aware that it is the responsibility of the home to ensure that all necessary checks must be in place prior to employment in order to safeguard the service users. The Commission had received a complaint in December 06 alleging that carers were employed without CRB, the evidence seen supported this. The home has a training programme and the acting manager reported that recent training included dementia awareness stages 1 and 2, infection control, Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 23 nutrition and wound care. Further training planned from April- Jul7 07 are first aid, prevention and treatment of pressure ulcers, basic food hygiene and dementia awareness. Information received from the provider indicated that there are 15 staff members who had completed the NVQ training at level 2 and above. Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 31,33,35,38 The home does not have a registered manager and there is a lack of clear lines of accountability for the service. The financial interests of the service users are safeguarded through very good accounting. The process of seeking the service users’ views is satisfactory. There is a satisfactory procedure in place to ensure the health and safety of the service users is promoted. However the management of substances that are hazardous to health was unsafe and put the service users at risk. Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 25 EVIDENCE: The home does not have a registered manager since the manager left in October last year. The acting manager has been a senior nurse at the home for a number of years. Service users and their relatives spoke highly of him. Comments received were that they would approach him and he dealt with any issues they raised. Staff also said he was supportive and “did his best”. The acting manager reported that there were two managers at the home. He dealt with the “clinical issues” and the administrator dealt with other things such as the duty roster. Staff spoken with thought that they would go to the acting manager for some things but were not clear about his overall responsibility for the management of the home. Staff reported that an audit of the service users’ views was undertaken last year, and there was a good response. The staff did not know the outcome of the audit as this had not been published. The provider undertakes monthly visits to the service and a copy is sent to the commission. The random visit of August 06 made a requirement that a copy of the report of the monthly visits is kept at the home so the manager can have access to them. This has been met and copies were available. The home has regular service users’ meetings, as part of the auditing and minutes of the recent meeting in March 07 was available. A sample of the service users’ personal allowance as managed by the home was seen as part of this visit. The home’s accountant has a robust and wellmanaged system in place. All the service users have personal account in their names and invoices are raised for all transactions. Receipts of moneys received and spent are maintained. All the invoices are numbered that allowed for easy auditing, a random check of three accounts was found to be accurate. Information received indicated that the home has an ongoing programme for the servicing of fire equipment, hoists, lift and emergency lighting. On the day of the visit substances that are hazardous to health were not maintained safely on two separate occasions. An immediate requirement was left at the time of the visit and the provider was required to take action to safeguard the safety of the people living at the home. It was also noted that a service user was being moved in a wheelchair without any footrest. This was brought to the staff’s attention and rectified at the time. Comment from a relative raised concerns that his wife who is wheelchair dependent had a broken footrest on her chair that had not been repaired/ replaced. Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 4 X X 2 Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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. 2 3 Standard OP9 OP9 OP16 Regulation 17(1) (a) 13(2) 17(2) Schedule 4 (11) 19 Requirement A record of all medication received in the home for the service users must be kept. Prescribed medication must only be used for the named service user. A record of all complaints received including action taken must be maintained at the home. All necessary checks must be completed for all staff prior to employment so as to protect the service users. The service users must have footrests as appropriate fitted to their wheelchairs to ensure their safety. All substances that are hazardous to health must be kept safely at all times to safeguard the wellbeing of the service users. This was an immediate requirement issued at the time of the visit. Timescale for action 15/06/07 15/06/07 15/06/07 4 OP29 15/06/07 5 OP38 12(1) 15/06/07 6 OP38 13(4) (c) 24/04/07 Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Linford Park Nursing Home DS0000011430.V332356.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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