Inspection on 10/03/09 for Link House

This inspection was carried out on 10th March 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Link House 20/05/08

Link House 10/05/07

Link House 04/05/06

Link House 30/11/05

Link House 24/05/05

Link House 19/10/04

Link House 25/05/04

Link House 09/01/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

CARE HOMES FOR OLDER PEOPLE Link House 15 Blenheim Road Raynes Park London SW20 9BA Lead Inspector Liz O`Reilly Unannounced Inspection 10:30 10 and 18th March 2009 th 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 Link House DS0000019135.V374452.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. Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Link House Address 15 Blenheim Road Raynes Park London SW20 9BA 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) 020 8545 4920 020 8332 1044 tessa.atkinson@ccht.org.uk Central & Cecil Housing Trust Manager post vacant Care Home 52 Category(ies) of Dementia (18), Old age, not falling within any registration, with number other category (34) of places Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th May 2008 Brief Description of the Service: Link House is a purpose built care home which has the capacity to provide nursing care for twenty older people and residential care for thirty two older people, eighteen of whom may have dementia. The home is owned and managed by Central and Cecil (CC) a charitable organisation who own and manage four other similar services in the Merton and Richmond area. Accommodation is provided over three floors with a lounge, dining room, kitchenette, bathrooms and single bedrooms available on all three floors. Access to enclosed gardens is to the rear and side of the home. Each floor is serviced by a lift. Link House is situated in a residential area of Raynes Park, close to the main A3 road, local bus services, churches of a number of denominations and local shops. The home is staffed twenty-four hours a day by trained nurse staff and care assistants. Three meals are provided each day with drinks and snacks available between meal times. The current range of fees for this home are £451 to £870 per week. Link House DS0000019135.V374452.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 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection was carried on 10th and 18th March 2009 by two Regulation Inspectors. The inspectors had the opportunity to speak with ten people who use the service, two visitors, two volunteers, six staff and the Registered Manager. Two completed surveys were returned by people who use the service and seven staff. At the time of these visits forty eight people were living at the service. Information provided from all of the above sources along with our observations during visits to the service have been used to reach the judgements made in this report. What the service does well: The two people who use the service who returned surveys both stated that they were happy living at Link House. Individuals we spoke to told us that they felt “quite comfortable” and that they liked their bedrooms. We received positive comments about individual staff members. People told us that “staff are always around and come and talk to us”, that “staff listen to me” and “these girls are very good, very nice”. We observed individual staff members supporting people in a sensitive and friendly manner. Particularly on the ground and second floor staff were seen to spend time talking with and laughing along with individuals they were supporting. Staff worked well between engaging individuals as well as the group in lounge areas. Staff told us they felt well supported by the manager. Staff were seen to respond quickly to changes in the health of individuals and take action to get a doctor or other health care professional involved. Medication is well managed. The scrap book and photo albums on the ground floor provide good reminders for people of recent activities as well as information for visitors on what people have been engaged in. We found individual staff members keen to improve the service and add to their knowledge and skills. Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The improvements made in care planning need to be continued and carried out across the service. Staff should include more details on individual preferences and follow up where information is to be sought from families. To make sure that individuals receive the support they need in the way they wish more details of how the care is to be provided needs to be available to staff. Everyone who uses the service whether permanently or on a short stay basis must be provided with a care plan. Senior staff should ensure that the assessments provided by social services are up to date and relevant. This will ensure that staff have some information on which to base an initial care plan. The improvement plan supplied after the last inspection told us that each care plan would include details of how each person is assessed for pain. However we found no evidence that this had been implemented. To assist in ensuring that individuals are not suffering untreated pain assessments need to be carried out. The recording of wound care should be improved to provide more clear details of the nursing care provided and the condition of wounds. Care planning needs to include wound and pressure area care, including details of any equipment to be used. Staff need to be checking that equipment is used correctly. Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 7 To ensure the safety of people who use the service and staff risk assessments need to include details of the size of sling to be used for the individual. As noted at the last inspection a clear record of food must be kept for each person. A review of the menu needs to be carried out along with how individuals are provided with choices. Consideration should be given to providing a pictorial menu and offering direct choices at the meal time. To provide a more homely atmosphere notices and information which relate to staff or working practices should be restricted to staff areas. The environment could be improved in line with good practice in dementia care. A review of the staffing levels on the nursing unit must be carried out taking into account the needs of the individuals living there. In order to keep up to date with good practice and improve skills and knowledge staff must be provided with more opportunities for training. All staff must be given clear information on what is acceptable, professional behaviour at work and maintaining dignity. Staff who lead teams should also be provided with support and training on leadership. To ensure the health and safety of people who use the service and staff the out of date checks on hoists and fixed electrical equipment need to be carried out. 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 be made available in other formats on request. Link House DS0000019135.V374452.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 Link House DS0000019135.V374452.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 People who use this service experience adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Before anyone moves into ‘this service’ pre admission assessments are carried out. The management should make sure that assessments received from social services are up to date and relate to this service. Initial care plans need to be produced from pre admission assessments so that staff have some understanding of the strengths and needs of each person and the support they may require from day one. This service does not provide intermediate care. EVIDENCE: People who use the service told us that family members visited the service on their behalf to “see if it was the right sort of place” for them. Individuals told us that everything was explained to them when they visited. Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 10 We found copies of the Service User Guide were available in the service. Staff told us that each person who lives in the home is provided with a copy. At the time of the last inspection of the service a recommendation was made that the Service User Guide should be made available in more user friendly formats. We were provided with a copy of the Service User Guide which is still in a written format. We saw that individual pre admission assessments were carried out, which assist in making sure that the service can meet the needs of the person. Copies of the assessments carried out by Care Managers from local authorities are also provided to the service. We noted that these assessments were not always up to date. In one instance the Care Management assessment was for a domiciliary care service and in another instance the assessment was for the care home the person had previously lived in. We found that initial care plans were not being complied from the information gained from pre admission assessments. Link House DS0000019135.V374452.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): 7, 8, 9, 10 & 11 People who use this service experience adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Although staff carry out assessments of the needs of each individual a care plan, setting out how the needs of the individual will be met is not available for each person. There is a lack of information on the social needs of each person and how these will be met. Further work needs to be done particularly around moving and handling, wound care records and communication. EVIDENCE: We looked at a sample of care plans and health care documents on each floor of the service. We found there have been some improvements in the information available which assists staff in meeting individual needs. Staff have taken time to add personal likes, dislikes and preferences. Care plans on the ground floor were signed by the individual concerned and staff. We saw Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 12 that care plans and risk assessments were being reviewed and up dated on a regular basis. Further work needs to be carried out to produce complete and person centred plans. We looked at the files for two people on the top floor. Although assessments of their individual needs had been done neither files contained a care plan. Staff told us that these people had not been confirmed as staying at the service permanently and that it would only be at that point that a care plan would be produced. One person had been living in the service since December 2008. The care plans seen on the first floor were functional and contained little, or in one instance, no information on providing stimulation, comfort or occupation for the person. At the time of the last inspection of the service a requirement was made that care planning must include information on how the needs and wishes of individuals will be met. Although staff have made some progress in this area we found a lack of detail in providing staff with information on how they were to provide support. In a number of instances care plans stated that staff should obtain more information from families particularly in relation to cultural and religious needs and or their wishes regarding death and dying. Statements such as “provide food he likes” gives little guidance to staff on what to supply. In one instance where a person was refusing to use a hoist the information to staff stated “two carers to move” with no further guidance on how to support the person to move or if any other equipment should be used. We looked at a sample of medication records and found these were up to date and well maintained. Medication was found to be stored appropriately. We noted that staff on the top floor had responded promptly to the health care needs of a new person to the service. Staff obtained chiropody services on the day of admission and the individual was seen by the GP the next day. Staff were quick to notice a deterioration in this person’s health and arranged a further GP visit on the same day they observed the changes. At the time of the last inspection a requirement was made that an up to date record of wound care be maintained to include the treatment given and clear information on the condition of any wound. The service told us through an improvement plan that a wound assessment tool would provide information along with photographs, body maps, details of the size of the wound, dressings to be used, frequency of dressing and a progress report. We found the wound treatment record gave little clear information on the condition or size of the wound. In one instance staff had simply noted the first name of the person who had treated the wound. We found no evidence of pain Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 13 assessments being carried out both generally and in relation to wound care other than being noted by the Tissue Viability Nurse. There was a lack of clear information for staff on maintaining pressure relieving equipment . We found instructions for staff on files stating they were to check a pressure relieving mattress was properly inflated but no further information on what the pressure should be or how to calculate the pressure for the individual. Notes made by the Tissue Viability Nurse stated, on more than one occasion, that an air mattress was found to be at the wrong pressure and that the alarm on the mattress was muted. Moving and handling assessments did not include the size of sling to be used and did not always state which type of hoist to use. We observed staff assisting one person using a standing hoist. Staff did not explain what they were going to do and did not talk to the person to offer reassurance. In another instance we saw poor practice from staff in helping an individual to get up from a chair. Further training should be provided to staff on moving and handling and communicating and supporting people when providing care. We are aware that the organisation are providing training for qualified staff on male catheterisation. Staff monitor and record the weight of each person who uses the service. Where individuals had lost weight it was not clear what actions had been taken. Staff had written on the weight record that they should be encouraged to eat more but this had not been entered on the care plans. Information on end of life care was basic. In one instance information on file indicated that family members had been consulted and that staff were to offer support to the person but no care plan for end of life care was in place. In two other instances care plans stated that families were to be consulted but this had not been carried through. The manager informed us that consideration was being give to joining in the Gold Standard framework for end of life care. Link House DS0000019135.V374452.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): 12, 13, 14 & 15 People who use this service experience adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People who use this service are provided with opportunities to take part in a variety of activities. However as noted in the last inspection of this service this is an area which could be improved. People who use the service feel that they can meet with friends or relatives at any time and in privacy. The record of food is inadequate. Further work needs to be done to make sure that people who use the service are provided with more opportunities to make informed choices. EVIDENCE: Two people who use the service told us through surveys that they enjoyed quizzes, outings, parties and painting classes. One person told us they enjoyed singing. One person on the ground floor told us they enjoyed “modelling with clay and having a sing song”. We were also informed that they had enjoyed a “lovely Christmas”. Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 15 On the ground floor we saw people in the lounge listening to music and watching television. Staff were seen to spend time talking with individuals. After lunch the majority of people had a short sleep. Later staff stated a ball game followed by a session listening to more music. People were invited to join in an art session in the afternoon. We saw staff on the top floor engaging people in singing and chatting. Staff were seen to communicate in a caring manner spending time with individuals as well as drawing in the whole group. Staff told us they recorded what activities individuals have been involved with in the daily records on the ground and second floor. On the first floor some people were in their rooms while others were in the lounge, with the television on. Two volunteers were providing people with drinks in the lounge. The care plan for one person on nursing floor said ‘unable to participate in activities of daily living’ and ‘watches television and enjoys a chat now and then’. This information is not detailed enough for staff to know what television programmes the person enjoys, how often during the day they like to chat and what they might like to chat about. A scrap book and photo album with pictures of events over the last year is available in the corridor on the ground floor. This is a good record and easily accessed by people who use the service and visitors to help people remember what they have done. Outings included a trip to Birdworld, shopping in Kingston and a Valentines meal. A list of activities people on the ground floor have participated in during the year, included: chair based exercises; sing along; art; quiz; film show; bingo; what the papers say; darts; music and movement; aromatherapy; musical quiz and religious service. Similar activities were noted on the top floor. A folder with activities on the first floor, records 19.1.09 TV, 9.2.09 TV and 26.2.09 film show and music and movement. The activities board in lounge was dated 17th February and was blank. Although one person visits the service to provide an arts and crafts session the majority of activities are provided by the staff group. We were provided with no evidence that staff had received training on providing occupation, activities or stimulation for people who use the service. As noted in the last inspection report, generally lounges, dining rooms and corridors contained very few items for people who use the service to engage with. This was particularly noticeable on the first and top floors. We recommended that staff look at providing items which people particularly those living with dementia can engage with such as; rummage boxes, pens, paper, Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 16 magazines, jewellery and or soft toys. Consideration should be given to encouraging people to take part in meaningful daily living activities. One person told us that the food was “very good” another person told us that they liked the more “traditional food” and that they would “like a cooked breakfast sometimes”. One person said “lunch was very good, although it isn’t always”. Two people said they “enjoyed lunch’” and “usually ok”. One person told us they “haven’t had anything to eat”, staff said they had eaten and offered the person a drink and a couple of biscuits. Staff told us they ask people during the afternoon what they want for lunch the following day. A number of people who use the service confirmed that they are asked what they want for lunch. Staff said “some people are not able to choose their meal”, so staff choose it for them. Two people told us they were not given any choice at meal times. As noted at the time of the last inspection of the service the manner in which people are offered choices needs to be reviewed. Access to the menu and the timing of requests for choices need to be improved. Consideration should be given to providing pictorial menus on each table and showing people, particularly those with short term memory difficulties, the actual food so that they can make a choice at the time of the meal. At the time of the last inspection of the service a requirement that a clear record of food be kept was made. This requirement has not been complied with. The manager informed us that the menu for the service had been reviewed after the last inspection. However the menu still shows the alternative for fish as another type of fish in two weeks out of four. There is no indication on the menu that anything is offered between supper and breakfast the next day and no alternatives to the supper menu are provided on the published menu. We observed staff supporting people through breakfast on the top floor of the home. Staff were seen to offer assistance in a sensitive and discreet manner. People who use the service told us they enjoyed their breakfast. Individuals were given time to eat at their own pace. We saw staff wake some individuals up to have a cup of tea and biscuits between meals. Individuals can choose to take their meals in the dining area or in their room. We saw staff supporting people to the dining room and lunch was taken in a calm unhurried manner. At the time of this inspection we were informed that no one who used the service required or had requested different food to that on the menu to meet their cultural needs. People who use the service told us they could have visitors at any time. Individuals can meet with their visitors in the privacy of their own room or in Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 17 the communal areas of the home according to their own choice. One person told us their family were made “very welcome” when they visited. Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 18 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): 16 & 18 People who use this service experience adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The service has a clear procedure for receiving and recording complaints. It may be useful to discuss how to respond to complaints with staff on a regular basis to ensure that they understand the importance of listening to people. To make sure that all staff understand their role and responsibilities in relation to safeguarding people all staff should receive regular training on this issue. EVIDENCE: People who use the service told us they would talk to staff or their relatives if they had a complaint. Systems are in place to record any complaint received along with actions taken. Information on how to make a complaint was seen to be available in the service. One relative told us that they have raised concerns before and don’t feel they are always listened to. Consideration should be given to reminding staff on how to respond when they receive a complaint. It is recommended that the complaints procedure is produced in a more user friendly format and that how to make a complaint or raise a concern is covered Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 19 at time of reviews and in residents meetings. No one we spoke to at the time of this inspection raised any complaints with the inspectors. We were provided with a record of staff training and this indicated that the vast majority of staff have not received any updated training on safeguarding people since their induction when they first started work in the service. In a number of instances this is many years ago. To ensure that people who use the service are safeguarded against abuse and that staff understand their responsibilities to report any allegation or suspicions of abuse, staff must be provided with updated training. Access to information on the local authority procedure for safeguarding people was available in the service. Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 20 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): 19, 20 & 26 People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People living at the home generally enjoy a comfortable and safe living environment. The environment could be improved to support and engage people who are living with dementia. Staff have made improvements to some of the bathrooms to make these areas less clinical in appearance. EVIDENCE: All areas of the service we saw during our visits were well decorated and maintained. Each person is provided with their own single bedroom accommodation with en suite toilet facilities. Individuals told us they liked their rooms and had Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 21 everything they needed. A number of bedrooms we saw had been personalised by the addition of photographs, ornaments and pictures. The ground floor lounge provides a homely and comfortable environment. The lounge areas of the first and second floor could be made more homely. As noted in the last inspection report consideration should be given to moving information displayed on notice boards in the corridors which relate to staff or visitors. Consideration should also be given to improving the environment in line with current good practice in dementia care. All areas we saw at the time of this inspection were clean and fresh. People who use the service told us that staff were “very good” at keeping the home clean. When asked about cleanliness one person told us it was “like living in a five star hotel”. Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 22 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): 27, 28, 29 & 30 People who use this service experience poor quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The way in which staff were working, the approach to people who use the service and the number of staff available on the first floor is of concern. In the majority of the service we found staff working in a supportive and friendly manner with individuals. However on the first floor this was less apparent. The lack of communication when providing care and the dispute between staff, clearly audible to anyone on this unit, must be addressed. The lack of training provided by the organisation is of concern. Records showed staff being provided with less than the minimum three days training each year. EVIDENCE: We observed some good interactions between staff and individuals who use the service. Staff were seen to offer support and guidance in a sensitive and caring manner. Individuals gave positive comments about the staff telling us “I like her” and “she’s nice”. One person told us “I am very happy with the staff here” and “staff are always there and listen to what you say to them”.. However these good practices need to be carried out throughout the service Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 23 where we observed staff missing opportunities for positive interactions with the people they were supporting. Of the seven staff surveys returned five raised concerns about the staffing levels on the first floor. Staff we spoke to during our visits also raised concerns about the staffing levels on this floor. Staff told us “there aren’t enough staff on the first floor” and “we could do more with people who use the service if we had more staff”. Visitors to the service told us they “don’t think three staff are enough to meet everyone’s needs when it takes two staff to help most people to go to the toilet or get into and out of bed”. Staff confirmed that it takes two staff to help most people on the first floor. One person told us they sometimes have to wait for staff to answer the call bell. This person felt that sometimes staff might be turning the bell off rather than coming in to see them. However the call bell system in this service cannot be turned off from outside the room. The qualified staff on the floor told us it takes two to two and a half hours to administer medication in the morning and this was confirmed by the manager. As the qualified member of staff is mostly occupied with the medication in the morning this leaves three care staff to meet the needs of individuals during this time. We were informed that only three people using the service on this floor are able to move around without the aid of a hoist. Therefore during the morning only one person at a time can be assisted to use the lavatory or get out of bed or a chair. During the course of this inspection we witnessed a heated discussion taking place between staff on this floor as to who should carry out certain tasks. This took place in a corridor within earshot of visitors and people who use the service. It is of serious concern that staff are not working as a team and more importantly that this type of discussion is taking place within earshot of people who use the service. We are of the opinion that this type of behaviour is unprofessional and shows a lack of leadership or understanding of the impact this could have on people who use the service who may feel that staff are reluctant to offer them assistance and support. We observed staff on this unit providing support to individuals without talking to them. This is poor practice. Action needs to be taken to carry out a review of the staffing levels on this unit, to provide support and training on leadership for those leading shifts and further training for individual staff on providing dignity in care. It is recommended that the way the unit organises work is reviewed to move away from task based care to more person centred support. Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 24 We found staffing levels on the other two units to be adequate to meet the needs of the people living at the service at the time of our visits. We also observed staff working well as a team and providing support to individuals in a sensitive manner. We looked at a sample of staff files. These were found to contain the relevant information on checks carried out before staff start work in the service. The organisation must ensure that a full employment history is obtained from each person so that any gaps in employment can be explained and recorded. We saw that references were sought from previous employers but in two instances these requests for references were not sent directly to the employer but to the home address of staff. This practice should be reviewed to make sure that the reference received is from the previous employing organisation. At the time of the last inspection a recommendation was made that the training provided should be matched to the needs of people using the service and should be of a sufficient depth to make sure that staff have a good understanding of the needs of people they support. It was also recommended that staff should have additional training on dementia care and person centred care and planning. We were provided with a copy of the training record for the service. This record indicated that the majority of staff were provided with less than the minimum three days training per year. A large number of staff had only received either one and a half or two days training in the last twelve months. This training mostly covered fire awareness and manual handling. It is of concern that staff have not been provided with more in depth training relating to the needs of the people they are supporting. We were informed by the manager following the last inspection of the service that senior staff would be provided with further training on working with people who are living with dementia. We could find no evidence that this has taken place. As noted in the last inspection report staff should be provided with access to information on current good practise in nursing and care sectors. Consideration should be given to subscribing to journals on dementia and nursing care. Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 25 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): 31, 35, 36 & 38 People who use this service experience adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Staff carry out regular checks to ensure the health and safety of people who use the service. The majority of these records were up to date however staff were not always recording the temperature of the water when assisting individuals into a bath or shower. Senior staff in the service need to take note of and action on any requirements made following inspections. Good records were seen to be maintained on any money held on behalf of people who use the service. EVIDENCE: Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 26 Since the last inspection of the service the manager has undergone the registration process. The manager has the appropriate qualifications needed to manage a service of this type. Staff gave us positive comments on the manager. Individual staff members told us they have regular contact with the manager and felt well supported by her. It is of concern that a number of requirements and recommendations made at the time of the last inspection of the service have not as yet been met. Senior staff in the service must ensure that all requirements are met and that recommendations are taken into consideration. We looked at a sample of the records for money held on behalf of individuals who use the service. These records were found to be well maintained, accurate and up to date. We are aware that the organisation has carries out it’s own quality monitoring which includes providing surveys for people involved in the service. We did not look at quality monitoring and consultation systems during this inspection. These will be looked at during the next inspection of the service. There are clear lines of accountability within the service with the manager supervising the deputy, the deputy providing supervision for senior and qualified staff who then supervise care staff. However the records of supervision we looked at had not been completed and signed by the staff or supervisor. Staff carry out regular checks on the building and equipment to ensure the health and safety of individuals. We looked at a sample of these records. Monthly fire drills were seen to be carried out with a record of those involved. The fire alarm system is checked every week and serviced every three months. An up to date gas safety check has been carried out. Records indicated that the checks on fixed electrical equipment was due in January of 2008. The documents we saw during this inspection indicated that staff were not always recording the temperature of the water before assisting individuals into a bath or shower. The record of inspection of the hoists in use indicated these should have been checked in January 2009. Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 27 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 2 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 3 2 X X 3 X X 3 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 3 2 X 2 Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 28 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(b)(c) Requirement Each person using the service must be provided with a care plan setting out their needs and wishes in relation to their physical, social, emotional, religious and cultural needs. To make sure that people who use the service are provided with the support they need in the way that they wish care plans must include details on how the needs and wishes of individuals will be met. 2. OP8 13(4) Staff must record actions taken where assessments or observations indicate risks or problems with the health or welfare of individuals. Any changes to needs must be recorded along with information on how these will be met on the individual care plan. 01/07/09 Timescale for action 01/07/09 3. OP8 12(1) To make sure that the health 01/07/09 and welfare of residents is protected a review of the manner in which pain is assessed and addressed must be carried DS0000019135.V374452.R01.S.doc Version 5.2 Page 29 Link House out. Timescale of 01/08/08 not met To make sure that no individual is left with untreated pain anyone assessed as at risk of pain or anyone who is unable to clearly express they are in pain must be regularly assessed. 4. OP8 17(1)(a)S chedule 3 (k) To ensure the health and welfare 01/07/09 of people who use the service an up to date record of wound care must be maintained. This record must include the treatment given and clear information on the condition of any wound. Timescale of 01/08/09 not met 5. OP8 13(4) To ensure the health and welfare of people who use the service staff must be provided with clear information on the correct use of pressure relieving equipment. Regular checks must be carried out and recorded to make sure that any pressure relieving equipment is operating correctly for the individual concerned. To ensure the health and welfare of people who use the service and staff clear information on the type of hoist and the size of sling to be used must be included in risk assessments and care planning. Action must be taken to ensure that staff do not carry out arguments in public areas and in particular within the hearing of people who use the service. To ensure the welfare and dignity of people who use this Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 30 15/06/09 6. OP8 13(4) 15/06/09 7. OP10 12(4) 12(5)(b) 15/06/09 8. OP15 17(2) Schedule 4 (13)16(2) (i) service staff must be provided with clear information on communicating with individuals when providing care. To ensure the health of people who use the service a clear record of food must be kept. Timescale of 01/08/09 not met. A review of the menu must be carried out to ensure that people who use the service are provided with a varied diet which meets their needs. Details of all choices on offer at meal times must be made available to people who use the service. Staff must make sure that people who use the service are offered a snack between the last meal of the day and breakfast the next day. 15/06/09 9. OP27 18(1)(a) To make sure that the needs of individuals are met a review of the staffing levels on the first floor must be carried out. This review must take into account the needs of the people living on this unit. To ensure that people who use the service are supported by a suitably skilled workforce the organisation must provide staff with additional opportunities for training. A copy of the training programme for this service for 2009/2010 must be provided to the Commission. 15/06/09 10. OP30 18(1)(c ) 01/07/09 11. OP38 13(4) To ensure the health and safety of people who use the service DS0000019135.V374452.R01.S.doc 15/06/09 Link House Version 5.2 Page 31 staff must record the temperature of the water before they assist anyone into a bath or shower. Checks on electrical equipment and hoists must be carried out within statutory timescales. 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. Refer to Standard OP1 Good Practice Recommendations The service user guide should be updated and be made available in user friendly formats such as large print or pictures. The organisation should ensure that any pre admission assessments provided by other professionals are up to date and relate to this service. The home should continue to look at ways to make the care plans more person centred and better reflect the individual’s life and preferences. The plan in place should direct the care to be person centred and less task based. Care plans need to give specific information about how the person likes the care and support to be delivered. Plans should include more details of the strengths of individuals. Consideration should be given to developing life story books. 4. OP11 To allow staff to meet the needs of individuals in relation to end of life care the wishes and needs of each person should be documented and care planning should be DS0000019135.V374452.R01.S.doc Version 5.2 Page 32 2. 3. OP3 OP7 Link House updated. 5. OP16 Consideration should be given to making the complaints procedure more accessible. Consideration should also be given to providing staff with regular reminders on how to deal with complaints so that people who use the service and or their representatives feel they are being listened to. Consideration should be given to providing key staff with training on activities based care. A review of the facilities and environment in communal areas of the service should be carried out. This should include improving the opportunities for people to be occupied and to find their way around. Notices which do not enhance the environment for people who use the service should be moved out of living areas. A review of mealtimes should be carried out to look at improving choice and access to menus. A review of the staff training should be carried out to ensure that the training provided is matched to the needs of people who use the service. The training provided should be of sufficient depth to make sure that staff have a good understanding of the needs of the people they support. It is recommended that staff have additional training on dementia care and person centred planning and care. 6. 7. OP12 OP12 8. OP15 9. OP30 Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. Extracts may not be used or reproduced without the express permission of CSCI Link House DS0000019135.V374452.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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