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Inspection on 30/01/08 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 30th January 2008.

CSCI found this care home to be providing an Poor service.

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

There is a pre admission process in place to ensure that the people using the service needs are assessed prior to moving into the home. Some of the staff have developed good relationships with the people using the service. The food looked appetising and well balanced. Risk assessments including assessments for risks of falls are completed for people as required, to minimise risks that have been identified.

What has improved since the last inspection?

Oral medication is only given to the people for whom it is prescribed. Some areas of the home have been refurbished and included carpets in the corridors. Curtain tracks have been put in place in shared bedrooms. Service users now have footplates attached to their wheelchairs for safety as required.

What the care home could do better:

The management of medication is poor and puts the people using the service at risk. This included some medications that were left unlocked. The management of prescribed wound dressings should be reviewed to meet with current guidance. This would ensure that the management of wounds are supported by good care practice. The lack of wound care plans is detrimental to the welfare and well being of people living at the service. The lack of regular reviews of assessments and care plans do not fully protect people using the service. There is a lack of adequate process in place to give people choices regarding meals and the way that their personal care needs are met. The complaint log does not accurately reflect all concerns/ complaints received. The lounge area identified, as having strong smell of urine must be looked into and the provider need to ensure that the problem is resolved. The provider must ensure that all checks are completed prior to staff employment to protect people living at the home. The management of substances that are detrimental to the health and safety of people was inadequate and must be addressed. There are inadequate call bells in the bedrooms and communal areas, which means that people cannot call for help when they need it. The provider must ensure that the home has a registered manager who has day- to- day control of the service. There must be a management structure in place which supports the organisations and running of the home in the best interests of people using the service.

CARE HOMES FOR OLDER PEOPLE Linford Park Nursing Home Linford Road Linford Ringwood Hampshire BH24 3HX Lead Inspector Anita Tengnah & Carole Payne . Unannounced Inspection 30th January 2008 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Linford Park Nursing Home DS0000011430.V357573.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.V357573.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 Position Vacant 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.V357573.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. 24th April 2007 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 £543-£750 Linford Park Nursing Home DS0000011430.V357573.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience Poor quality outcomes An unannounced visit to the service was undertaken as part of the inspection on the 30th January 2008. Two inspectors carried out this unannounced visit. The process included a tour of the service where a number of the bedrooms, communal areas, kitchen, and bathrooms were viewed. As part of case tracking 6 staff and 5 service users views were sought and care records were looked at. Information gained from the Annual Quality Assurance Assessment (AQAA) 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. We also sent out service users surveys to people using the service, their relatives and other professionals who regularly have contacts with the service. We spoke to two visitors and gave feedback to the provider following the visit. The service has been without a registered manager for the past 18 months. What the service does well: What has improved since the last inspection? Oral medication is only given to the people for whom it is prescribed. Some areas of the home have been refurbished and included carpets in the corridors. Curtain tracks have been put in place in shared bedrooms. Linford Park Nursing Home DS0000011430.V357573.R01.S.doc Version 5.2 Page 6 Service users now have footplates attached to their wheelchairs for safety as required. 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. The summary of this inspection report can Linford Park Nursing Home DS0000011430.V357573.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. Linford Park Nursing Home DS0000011430.V357573.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.V357573.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 3,6 There is a pre- admission assessment in place that looks at the needs of people before they move into the service. Further development is needed to ensure that all care needs are identified. The service does not provide intermediate care EVIDENCE: The pre admission records of three recently admitted service users were looked at as part of case tracking. A pre admission assessment of needs was carried out prior to admission. Assessments of needs included manual handling needs assessments, likes and dislikes and brief social history. The staff reported that these assessments are used in the formation of care plans on admission. The assessments could be further developed to included input from carers/ family, as there was no evidence to show that this did happen. This Linford Park Nursing Home DS0000011430.V357573.R01.S.doc Version 5.2 Page 10 would ensure that all relevant information is available prior to the service users moving into the service. This is pertinent as some people using the service are not able to participate in the assessment process due to their mental frailty. Comments from relatives indicated that information was received on admission to the service from social services. The person in charge confirmed that the home continues not to provide intermediate care. Linford Park Nursing Home DS0000011430.V357573.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 poor. This judgement has been made using available evidence including a visit to this service. 7,8,9,10 The care plans contained some information however they did not always inform how the current needs of people living at the home are to be met. The lack of reviews of care plans does not fully protect the people who use the service to ensure that their needs are updated and responded to. The lack of wound care plans is to the detriment of people using the service. Some aspects of the medication management were detrimental to people living there. The service users were treated with respect. However some people do not feel that their right to privacy is always respected. EVIDENCE: Linford Park Nursing Home DS0000011430.V357573.R01.S.doc Version 5.2 Page 12 The care plans of 6 people living at the home were looked at as part of this visit to see how the home plans to meet the needs of the service users. The care plans contained information about the assessed needs of the service users and actions required in order to meet them. These included assessments such as manual handling, dietary needs, continence, fall assessments and their psychological needs. There were no night care plans to demonstrate how these needs would be met. There were some care plans that showed that relatives were involved in the care planning. Daily records were maintained of the care given. Although care plans were detailed these did not always link to the current care needs of people using the service. The daily record for one of the person seen indicated they had developed a pressure ulcer to their sacrum with photographic evidence included. However there was no care plan to show how this would be treated and the assessment for that period to date indicated that the pressure areas were intact. This was contrary to evidence in her care records. The nurse in charge reported that the pressure ulcer might have been a burn from the radiator in her bedroom. There was no risk assessment or action plan in place to show how this would be managed for this person’s safety. Staff reported that the pressure ulcer has now healed. The lack of accurate assessment and care plan also related to dietary assessment and weight loss for another resident. The staff had identified that the resident had lost weight, however there was no action plan in place to show what was being done to resolve this problem. Care plans therefore did not always address the diverse needs of people. Another person had wound dressing to their legs that staff confirmed was being treated for leg ulcers. Again there were no would assessments and care plans in place to demonstrate how this wound was being managed. These were brought to the attention of the person in charge and the provider at the time of the visit. As part of the assessment people using the service are asked about their preferences and being cared by people of the same sex if they chose. One person spoken with said that although they had indicated preference for carers of the same gender providing their personal care, however this did not always happen. Evidence gathered indicated that there was no carer of that gender on the wing on the day of the visit, although they were allocated elsewhere in the service. This showed hat people receiving care are not in charge of their own choices with regards to daily life. We noted that not all the care plans and assessments were reviewed on regular basis to reflect the changing needs of people using the service. Those that had been reviewed did not accurately identify their current care needs and actions needed to resolve those needs. These were brought to the attention of the provider at the time of the visit. Linford Park Nursing Home DS0000011430.V357573.R01.S.doc Version 5.2 Page 13 The people using the service were registered with the local surgery and there was a good system in place in recording GP visits and any changes in treatment was recorded in the daily records. The person in charge was aware of people’s access to NHS healthcare and records of chiropody were maintained. Comments from relatives included ” the home lets me know if dad is taken to hospital”. A relative said that the staff did not accompany people when they are taken to hospital at night as an emergency. Comment was ““ this was very scary for someone with Alzheimer”. This was brought to the attention of the staff and provider. The nurse in charge reported that staff only provided escort when they attend out patient appointment. Care record seen showed that there was conflicting instruction for one person who had recently attended an eye clinic as staff were relying on information from the resident. This has led to the resident not receiving their eye drops and problem had remained unresolved on the day of the visit. Staff reported that they went and saw people that remained in their bedrooms when they could. The nurse in charge was unable to say how often checks were made for those with no access/ unable to use call bells and those who remained in bed. One resident was found in the corridor with little clothing to preserve her dignity. Another resident was seen with very red cheeks as she has been lying in bed with the sun coming through the window. This was brought to the attention of staff and the curtain was partially drawn to shade her face. Comment from people we surveyed raised issues about ““some health care staff understanding of social care values regarding dignity and privacy”. The home has a medication procedure in place and the nurse in charge confirmed that trained nurses are responsible for medication management at the service. The home maintains Medication Administration Record (MAR) sheets for each of the people at the home. MAR sheets seen indicated that staff recorded medication administered to the residents. Medication in the drug trolley and controlled drugs were kept locked. We found that the drug fridge on the ground floor was left unlocked and putting people using the service at high risks. The fridge contained medication such as oral suspensions and different types of Insulin. Staff were required to lock the fridge immediately. The antibiotic in the fridge did not contain the date of opening as required to ensure that medication is used within set time and this included Insulin that was not labelled with the resident‘s name. We noted that staff had administered variable dosages of a medication to a resident, who was prescribed to take one tablet once a day. The staff were unable to account for this discrepancy. This was brought to the attention of Linford Park Nursing Home DS0000011430.V357573.R01.S.doc Version 5.2 Page 14 the staff and the provider. Following the visit the service wrote to the commission and said that the Doctor had changed the dose. This still does not explain why different dosages were administered to the resident over a period of time. We requested to look at record of the medication received for this resident relating to this particular medication. This was not available at the time of the visit. This has put the service user at risk of receiving incorrect dosage; recording was not in accordance with what the GP had prescribed and the record on the MAR sheet. There were a number of wound dressings that were found at the service. Some of these were either no longer in use or belonged to people no longer at the service. This was brought to the attention of the nurse in charge and must be disposed of according to current guidance. There is a risk that these could be used for other people and putting them at risk of cross infection. As discussed a review of the current procedure for ordering medication for the residents must be looked into to ensure that they meet with current good practice guidance including the Royal Pharmaceutical Guidelines. From medication records seen, medication is now only given for the people that they are prescribed for. Surveys returned indicated that there was a mixed response regarding privacy and dignity at the service. Comment included” “we think they do a good job. We visit father every 7-10 days and found no problems”. Another comment was “I am not sure it is right for male carers to wash and dress elderly women. Although my mum would not have liked this, her sensibilities have now gone”. As previously reported one of the resident spoken with was unhappy about not receiving care support from a person of the gender of their choice. Interaction observed throughout the day indicated that the staff interacted well with the residents. Linford Park Nursing Home DS0000011430.V357573.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. There are some activities available, however these do not meet the needs of all the residents. There is a good process in place that supports the residents to maintain contact with their family and friends. The meals looked well presented and appetising. The way that choices are offered is inadequate and the records of meals provided are poor. EVIDENCE: The home has an activity coordinator and there was a programme of activities available. The staff reported that some of the residents had been baking cake on the day of the visit. Comments received indicated that some form of activities were available and three responses were “always “ and five were “sometimes” when asked if there are activities arranged at the home that they can take part in. Records seen indicated that a life profile had been developed for some of the people living at the home. It was not evident how this information was used in order to provide suitable activities for the residents. Linford Park Nursing Home DS0000011430.V357573.R01.S.doc Version 5.2 Page 16 One of the resident expressed his concerns of have being left in their bedroom and not having any kind of activities and would like to go out. The home has an open visiting policy and comments received and those spoken with at the time of the visit confirmed that there was no restriction on visiting. Comments included” “We think they do a good job. We visit father every 7-10 days and found no problems”. A relative commented” “My visits are pleasant experience and I am encouraged to take my mum out”. Another comment was “I work full-time and often visit after office hours. It can be trying to wait on the doorstep, sometimes for several minutes, repeatedly ringing the doorbell for admittance.” Other comments were that they were always made welcomed when they visited and are encouraged to take their relatives out. The home maintained a record of visitors to the service as required. The chef confirmed that there is a planned menu that is rotated on a regular basis. Comment cards received and the service users spoken with said that they “usually” liked the meals, hot drinks and cold drinks were available. Comments included “.” The food is all right, my dad has a good appetite”. Other comments were ” Lunch not always suitable as service users were given sweet and sour dish. “Never seen any fruit” “Not enough drinks”. We were able to ascertain that on one of the wings there was a menu available where choices had been recorded. However on the other wing the three staff stated that the menu list is done on a Monday and the number of meals required was seen on the kitchen notice board and pointed out by the chef. There was no evidence to show how choices are offered. There were no records of what meals people had taken on one of the wings except for number of main courses and pureed diets that had been provided. The chef confirmed that this was their normal working practice. The people spoken with were not aware of what the meal choices were at the time of the visit. Only one person said that there has been a menu choice offered on the previous day, he has been at the service for some time. Lunchtime meal was observed and the food looked appetising and well presented. The staff informed the residents what the different meal courses were and staff were observed to provide assistance with meals in a respectful manner. The lack of choices regarding meals was brought to the attention of the provider who agreed that action would be taken to offer choices and records are maintained in order to meet the needs of the residents. Linford Park Nursing Home DS0000011430.V357573.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 has started recording complaints received, however they do not reflect all complaints received. There is an increase in staff training in safeguarding, however the home does not always follow the procedure in safeguarding adults. This can be to the detriment of people using the service. EVIDENCE: The home has a complaint policy and procedure in place. The staff spoken with said that they would talk to the nurse in charge. Comments received from our surveys indicated that five people said they were unsure about the complaint procedure. Three said “usually” the service had responded when they have raised concerns. One of them said that they “knew now”, as they had recently complained to the provider. The complaint log seen indicated that one complaint had been received since the last inspection. The commission has received three concerns that had been referred to as safeguarding. Although the home had been involved in the safeguarding investigations there were no records of these at the service. The recent survey showed that a relative had made a complaint and the provider had dealt with it, again this was not recorded in the complaint log. The provider is aware that all concerns/ complaints and issues raised must be Linford Park Nursing Home DS0000011430.V357573.R01.S.doc Version 5.2 Page 18 recorded in the complaint log. This was raised as a requirement at the last visit and again discussed with the provider at the time of the visit. Information from the surveys indicates that the people remain unsure Who is responsible for complaints. Comments included ” Still waiting for a manager who left over a year ago - so speak with either Amelia at the flat, or Charles senior nurse. Unsure as to previous inspection who to ask.” The home has the Hampshire Adult Protection procedure in place and the provider confirmed that there is also a home procedure to inform staff of action needed for any allegations of abuse. Staff spoken with were aware what constituted abuse and said that they would go and report to the person in charge. The commission received an allegation of physical abuse involving a staff member that was not reported to us and the provider had dealt with. The provider is aware that as part of the procedure, all allegations of abuse must be reported to the appropriate authority to ensure that the people living at the service are protected. There has been an increase in staff training in safeguarding from records seen at the time of the visit. Linford Park Nursing Home DS0000011430.V357573.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 was warm and there is a programme of refurbishment in place. The offensive odour as identified must be resolved. The infection control procedures are satisfactory. However there was inadequate staff hours devoted to ensuring that a clean environment is maintained for the people living at the service, staff and visitors. EVIDENCE: Accommodation is provided on two separate wings. Information form the AQAA indicated that the home has put in place a programme of refurbishment that included renovations of carpets in the corridor. Some of the bedrooms seen were comfortable and personalised. Staff reported that this was dependent on Linford Park Nursing Home DS0000011430.V357573.R01.S.doc Version 5.2 Page 20 their family to assist them. Other bedrooms were bland in particular the shared bedrooms. The home was clean except for one of the communal lounge that had strong smell of urine. The provider was aware of this problem and action is required to resolve this and ensure that people living at the home are provided with a clean and comfortable environment. Comments received and people spoken to say that the home was usually clean and homely. Other comments included ” “It constantly smells of urine” “Her bedroom although old and seedy is usually clean” The lounge area is “very sad”. “I wish some of the money would be spent doing up the home.” “Why do we think that these people do not mind these conditions”. We observed that some of the bedrooms and communal toilets and bathroom did not have call bells access. The manager stated that they had recently undertaken an inventory and these were in place, however this would be looked into and addressed as required. The home has a laundry and all laundry is undertaken internally. The laundry was well maintained and equipped with appropriate washing machines and driers. The laundry room was well maintained and clean and the laundry lady said that all clothing was marked to ensure that this did not get mislaid. A relative we surveyed had commented that the clothing was not always returned to the rightful owner. The home has in place infection control procedures and training in infection control prevention and management was available to staff. Linford Park Nursing Home DS0000011430.V357573.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 adequate. This judgement has been made using available evidence including a visit to this service. 27,28,29,30 There is a duty roster for staff and the staffing was adequate on the day of the visit. There is a staff induction in place; this needs to be further developed to meet with current guidance. There is an ongoing training programme inn place. A training matrix was being developed to help identify any gaps in staff training. Most staff had checks completed prior to employment. However this did not apply to all staff and there was failure in meeting visa requirement for some staff. EVIDENCE: The home is managed as two separate wings and the duty roster seen indicated that the carers and trained staff are allocated for each wing. The roster indicated that there were two trained and four carers on one wing and one trained and carers on the other. There was one staff responsible for the Linford Park Nursing Home DS0000011430.V357573.R01.S.doc Version 5.2 Page 22 cleaning on both wings, on the day of the visit. There was no documentary evidence to indicate that this was exceptional circumstance. The duty roster for domestic staff had been requested and staff had confirmed that there is no roster for domestic staff. The nurse in charge stated that there was adequate staff to meet the needs of the residents. Other staff said that “staffing was all right” and they helped each other. Comments received from our surveys were positive with regards to the staff. Some of the comments were “The staff seem to really care.” ““They try their best with limited staff”. Another resident spoken with said that they waited for a long time for r response to their call bells in particular at weekends. Another comment was at the beginning when their father was newly admitted staff were available to sit with the residents. However “Now due to staff shortage no one seems to be with the patients. Very sad”. We observed that the staff interacted well with the residents and had developed good relationships with them. Some of the surveys raised concerns about the staff understanding and one of the resident said” sometimes they do not understand what I want, they do their best”. Other comments were “the difficulty of some of the patients to communicate with the staff because of the staff language barrier”. Some residents were seen in their rooms and staff said they came in when they could. It was noted that not all of the residents had access to call bells. One of the resident told the inspectors that when they ask for assistance the carers are sometimes not happy and say ” not you again.” The provider must ensure that there is a continuous process in place and that the residents who are left in their rooms have appropriate supervision to ensure that they are safe and checked regularly. The staffing levels must reflect the assessed needs of people living at the home and must include domestic hours. Records seen indicated that there is an in house induction process in place. The nurse charge confirmed that the induction programme does not meet the Skills for Care guidance and must be developed. Information from the AQAA indicated that there are seventeen staff members who have completed National Vocational Qualification at level 2 and above and four of the carers were working to achieve this qualification. There is a training programme in place and recent training included fire safety, moving and handling, prevention of abuse. The administrator was in the process of developing a training matrix that would make staff training records more accessible. Training records seen included recent training in fire safety, fire safety, infection control and dementia care. Linford Park Nursing Home DS0000011430.V357573.R01.S.doc Version 5.2 Page 23 A sample of four staff records was looked at as part of this visit. All the staff records were maintained safely and bound. All the new staff completed an application form and notes of interviews were maintained. Three of the staff records indicated that they had checks such as CRB and POVA first prior to commencing work. However one of the carers had started without her CRB clearance. The provider is aware that this should only occur in exceptional circumstances and staff must supervised until full clearance received. One staff member was employed on a student visa with clear requirement that she was allowed to work only 20 hours and to attend college for 18 hours a week. The duty roster showed that she worked 48 hours one week and 60 hours the next week. The provider reported that she thought that this had changed and students were allowed to work over the 20 hours. We had requested that evidence of this was sent to us. Since the visit we have received confirmation that only staff who are undertaking NVQ vocational training can work full time. In addition these staff concerned must have documents from the home office such as a yellow card, which was not available in the records seen. Linford Park Nursing Home DS0000011430.V357573.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 poor. This judgement has been made using available evidence including a visit to this service. 31,33,35,38. The home remains without a registered manager. There is therefore a lack of clear lines of accountability within the service to ensure that there is leadership Within the home organising and overseeing the interest and protection of people living there. The financial interests of the service users are safeguarded through good accounting. The process of seeking the residents views is satisfactory, although it must be demonstrated that views are sought in all key areas and feedback responded to and the service is responsive to promoting and meeting of the people’s wishes and choices. Linford Park Nursing Home DS0000011430.V357573.R01.S.doc Version 5.2 Page 25 There are unsatisfactory practices with regards to medication management and substances that are hazardous to health. These put the residents at risks. EVIDENCE: The home does not have a registered manager and has been without one since the last manager left in 2006. We have been in communication with the provider regarding a replacement. The provider reported that they are looking into this and this remains unresolved. Staff and people spoken with and comments received that people are unsure about the management structure at the service. Staff stated that the nurse in charge/ acting manager was responsible for one of the unit and sometimes helped out on the other unit. Staff reported that “sometimes it is difficult to know who to go to and we go to whoever is trained nurse on the shift”. There are no clear lines of accountability for the service. The home needs a manager in place, who is suitable to apply for registration with the Commission for Social Care Inspection. A sample of personal allowance as managed by the home for people living at the service was looked at. There was a clear audit trail of all transactions. All moneys were maintained securely. Receipts of transactions were available. The money for each person was maintained individually and designated staff had access to the personal allowances. We noted that the people were being helped to move around in their wheelchairs and footplates were attached, to support their safety. Information received indicated that there is an ongoing programme for the servicing of fire equipment, hoists, lift and emergency lighting. Record from the AQAA showed that they were all completed in the last 6-12 months. All substances that are hazardous to health (COSHH) were not maintained safely. As reported in the medication section the drug fridge was unlocked with a number of medications inside that put the residents at risks. Information from the AQAA indicated that the service had last reviewed their policies and procedures in June 2007 in order to reflect regulations and current good practice guidance. Linford Park Nursing Home DS0000011430.V357573.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 4 X X 1 Linford Park Nursing Home DS0000011430.V357573.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Care plans must accurately reflect current assessed needs and action required to meet the people’s needs. Care plans must be updated and reviewed to reflect any changes in the people’ needs. The incidence of pressure sores and treatment provided such as wound care plan must be available for people as required The provider must ensure that all prescribed medications are kept locked for the safety of people living at the service. The provider must ensure that arrangements are in place for the safe administration, handling, recording of medication at all times. A record of all complaints received including action taken must be maintained at the home. This is a repeated requirement of 15/06/07. All necessary checks must be DS0000011430.V357573.R01.S.doc Timescale for action 15/03/08 2 OP8 17(1) (a) Schedule 3 (p) 13(2) 15/03/08 3 OP9 30/01/08 4 OP9 17 (1) (a Schedule 3 17(2) Schedule 4 (11) 15/03/08 5. OP16 15/03/08 6. OP29 19 15/03/08 Page 28 Linford Park Nursing Home Version 5.2 completed for all staff prior to employment so as to protect the service users. This is a repeated requirement of 15/06/07 7 OP27 18(1) (a) The provider must ensure that there are adequate staff including domestic staff to meet the needs of people living at the home at all times. The provider must put in place a recorded staff rota that shows what staff are on duty day at any time during the day and night and in what capacity they are employed. The provider must ensure that there is a registered manager at the service. There is clear lines accountability within the home, so that the home is organised and run in the best interests of the residents. All substances that are hazardous to health must be kept safely at all times to safeguard the wellbeing of the service users. This is a repeated requirement of 24/04/07 15/03/08 8 OP27 17(2) Schedule 4. 15/03/08 9 OP31 12(1) 8 15/03/08 10. OP38 13(4) (c) 30/01/08 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.V357573.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Kent ME16 9NT 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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