Inspection on 15/11/05 for Link House

This inspection was carried out on 15th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Link House 27/10/06

Link House 29/07/05

Link House 12/01/05

Link House 21/09/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Link House Main Road Withern Alford Lincolnshire LN13 0NB Lead Inspector Kima Sutherland-Dee Unannounced Inspection 15th November 2005 10:00 Link House DS0000002378.V266652.R01.S.doc Version 5.0 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 DS0000002378.V266652.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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 DS0000002378.V266652.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Link House Address Main Road Withern Alford Lincolnshire LN13 0NB 01507 450403 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) Boulevard Care Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Link House DS0000002378.V266652.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th July 2005 Brief Description of the Service: Link House is situated in the village of Withern, which is between the market town of Louth and the coastal resort of Mablethorpe. The village has a post office, general store and public house. Recreational facilities are accessed, via public transport, or booking the providers mini bus and are mainly in the nearby towns of Louth, Skegness and Mablethorpe. Service users choose from a programme of leisure and learning opportunities, which are supported by the home staff. The home also supports service users to access community employment or education. The home is registered to accommodate up to eight service users with learning disabilities, who require personal care. Link House DS0000002378.V266652.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one morning and included spending time with 3 residents, talking to the staff and support managers, touring the home and reviewing a sample of the records. What the service does well: What has improved since the last inspection? What they could do better: The manager needs to change the medication administration system and this was agreed at the inspection. They also need to put protocols in place for administering medication prescribed ‘as required’ so that staff are clear about why they are giving medicines. Link House DS0000002378.V266652.R01.S.doc Version 5.0 Page 6 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. Link House DS0000002378.V266652.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Link House DS0000002378.V266652.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were will be assessed at the next inspection. EVIDENCE: Link House DS0000002378.V266652.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10. The home promotes independence and offers choices. The staff are considerate to the residents but improvements need to be made in the way information is written. EVIDENCE: A sample of 3 care plans were seen and they contained detailed information about each resident that the staff use to inform their care. The residents said they know about their care plans and they go through them with their key workers. The residents meet formally with their key workers once a month to discuss their care but they also seek them out informally to chat and discuss any issues or for support. The care plans do record each person’s aspirations and wishes where these have been expressed. They also record detailed information about the resident’s background and history and their likes and dislikes. Each resident has a formal review annually and they can invite who ever they choose, this includes their family, their social worker and the staff. Link House DS0000002378.V266652.R01.S.doc Version 5.0 Page 10 The staff maintain contact sheets where they write about a residents progress or issues that require communication with other staff. The records are kept securely in the locked office and the residents know that they have access to them. The staff spoke considerately about the residents to the inspector, but 1 of the care plans contained two sentences that were written in a derogatory way. This was discussed with the manager who had previously instructed staff about this and would take further action. The care plans did contain risk assessments that ensure the residents can take assessed risks in their best interests. Link House DS0000002378.V266652.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 14, 15, 17. The home offers the residents support to make and keep appropriate relationships with family and friends and the residents are involved in a wide variety of activities. The residents are able to choose their food and to enjoy their meals. EVIDENCE: The care plans show that the residents have opportunities to develop their skills and that they are supported by the staff. Two of the residents gave the inspector a tour of their home and they showed a display of photographs from recent holidays, which they had enjoyed. The notice board has information about events and trips and there is an activities list. The residents spoke about what they do and they were offered opportunities to take part in age appropriate events. The care plans also show that the residents have contact with their family and friends and that they are helped to maintain this by the staff. Link House DS0000002378.V266652.R01.S.doc Version 5.0 Page 12 The inspector saw the menus, which are chosen by all the residents, and the fridge and freezer were well stocked. Those residents that are able can have access to the kitchen to make their own drinks and snacks and a number of residents enjoy making meals with staff support. The residents said they like the food and the dining room is comfortable and pleasant. The staff sit with the residents for their meals. Link House DS0000002378.V266652.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 The staff do support the residents with personal care appropriately and they also offer emotional support. Health care needs are met and treatments are carried out. The medication administration system needs to change and improve. EVIDENCE: The care plans detail the health care needs of each resident and how these are met. Medical appointments are recorded along with the outcomes and treatments. Although the care plans are useful the inspector discussed the need to add each persons preferred daily routine such as when they like to get up and go to bed. This would help the staff to make judgements about the residents health and if any routines had changed. The residents did say that the staff were kind and that they helped them with their personal care when this was needed. On inspection it was noted that the home still secondary dispenses medication form the original containers into personal tablet wallets. The manager agreed to change this system and dispense directly from the prescribed containers that record the precise details of each tablet. Link House DS0000002378.V266652.R01.S.doc Version 5.0 Page 14 The home does not have any protocols for when staff administer medication that is prescribed ‘as required’ P.R.N. This would help staff to identify under what circumstances it should be given and for how long as well as the dosage and when to seek medical attention. Link House DS0000002378.V266652.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 The home and the organisation have systems for taking and acting on complaints and the resident’s views are sought. EVIDENCE: The residents told the inspector how they would complain if they needed to. Regular residents meetings are held and the residents said the staff listened them to. The home has a complaints policy and this is available in the service users guide, there is also a pictorial copy on the resident’s notice board. Link House DS0000002378.V266652.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 30 The home offers comfortable and clean private and communal space. Each bedroom is locked allowing privacy and individual and to the taste of the residents. The availability of the toilet downstairs needs to be addressed. EVIDENCE: Two residents showed the inspector around the home. The resident’s bedrooms are well-furnished and very individuals with plenty of personal possessions that reflect the individual interests. Each resident holds a key to their own rooms and the manager has a master key for emergencies. The communal areas are comfortably furnished and well decorated. There are two toilets upstairs and one downstairs. The downstairs one is kept locked and although some residents use it for baths they have to ask staff to open it or go upstairs to use the toilet. The inspector discussed this with the manager and although the inspector understands that the staff have a right to use a clean and pleasant bathroom, it would be more suitable to make alternative arrangements so that the residents have open access to a toilet downstairs. Link House DS0000002378.V266652.R01.S.doc Version 5.0 Page 17 The home has a large garden area and patio. The support manager informed the inspector that the patio would be repaired in 2006, although in a poor state it is still safe for the resident’s top use. One resident showed the inspector around the garden and enjoyed pointing out the plants and smelling their scent. The residents spoke about a barbeque last summer when they invited their friends from other homes. The home was clean and the staff and residents are involved in cleaning different areas daily. Link House DS0000002378.V266652.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 35, 36 Although the majority of staff are new to the home the residents know the senior managers are appropriately supervising them and them. Training and supervision are taking place and the staff team said they were well motivated. The induction of the acting manager needs to be recorded. EVIDENCE: The home has recently had a number of new staff due to changes in staff deployment in the care organisation. Staff numbers on duty have improved and the home has recently advertised for the last vacant post. A new acting manager has transferred from another home where they were a team leader. They stated that they have received good support form their senior manager. The visitor’s book confirmed that the senior manager had been at the home every day in the previous week. Although it was clear that an induction was carried out this was not recorded and the senior manager agreed that this should be done retrospectively. The acting manager has not received their new job description or contract and this was discussed with the senior manager during the inspection. The new acting manager has completed N.V.Q 2 and almost completed N. V.Q 3 they will then register for the manager’s award. Link House DS0000002378.V266652.R01.S.doc Version 5.0 Page 19 Staff have regular supervision and the training records showed that both statutory and specialist courses had taken place including fire training. The acting manager said that the new staff team were working well together and that they were enthusiastic about helping the residents achieve their goals when the day service closes. Link House DS0000002378.V266652.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 40, 42 The home maintains safety and its policies are in the resident’s best interests. EVIDENCE: The homes policies are available to all staff and the senior manager discussed the policy on giving and receiving gifts between staff and residents. One resident said they have purchased items from a member of staff and the senior manager stated that this had been authorised and that value for money had been checked. Although this policy is not encouraged the manager stated that if a resident chooses to do this, the transaction must always be agreed. The home has records of servicing of equipment and installations and the insurance certificate is displayed, and valid until March 2006. Kitchen safety is maintained and temperatures of the freezer, fridge and cooked meats are all recorded. The home complies with C.O.S.H.H (control of substances hazardous to health) regulations and all products are kept locked in the utility room. Link House DS0000002378.V266652.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 2 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 2 3 X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 3 X 3 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Link House Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score X X X 3 X 3 X DS0000002378.V266652.R01.S.doc Version 5.0 Page 22 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 YA10 Regulation 12(4)(a) Requirement The registered person must ensure that all information written or communicated about the residents must be appropriate and that the resident could read or hear it without offence. The registered person must review medication administration arrangements to ensure that they comply with Royal Pharmaceutical Society guidelines. Carried over from September 05. New timescale 30/12/05 The registered person must make arrangements for the free availability and open access of the downstairs toilet for all residents. Timescale for action 30/12/05 2. YA20 13(2) 30/12/05 3. YA27 23(2)(j) 30/12/05 Link House DS0000002378.V266652.R01.S.doc Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA20 YA36 Good Practice Recommendations It is recommended that individual protocols are in place for the administration of non-prescribed medication, and the GP has authorised this. It is recommended that the induction of the acting manager is recorded and kept on file at the home. Link House DS0000002378.V266652.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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