Inspection on 20/05/08 for Link House

This inspection was carried out on 20th May 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Link House 10/03/09

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Link House 15 Blenheim Road Raynes Park London SW20 9BA Lead Inspector Liz O’Reilly Unannounced Inspection 20th May 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Link House DS0000019135.V363945.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.V363945.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.V363945.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Nursing Places To include no more than twenty service users requiring nursing care at any one time. Nursing Unit 1st Floor - Qualified Staff A qualified 1st level nurse must be available on the nursing unit at all times. This person must not have any management responsibilities for the home other than within the nursing unit. Nursing Unit 1st Floor - Care Staff 7.30am to 3pm three care staff must be available on the unit. 2.45pm to 9.30pm two care staff must be available on the unit. 9.30pm to 7.30am one care assistant must be available on the unit. Dementia Care Unit 2nd Floor - Care Staff 7.30am to 3pm three care staff must be available. 2.45pm to 9.30pm three care staff must be available. 9.30pm to 7.30am two care staff must be available, one of which will be the designated senior carer in charge of the home, in the absence of the Manager or Deputy Manager and able to offer assistance and guidance for carers throughout the home. Residential Unit Ground Floor - Care Staff 7.30am to 3pm two care staff must be available. 2.45pm to 9.30pm two care staff must be available. 9.30pm to 7.30am one care assistant must be available. Management One full time Manager 40 hours per week. One full time Deputy Manager 40 hours per week. A member of the management team to be available seven days each week. Ancillary Staff Administrative Staff 37.5 hours per week. Domestic Staff 136.5 hours per week. Cook 49 hours per week. Kitchen Assistants 102 hours per week. Laundry Staff 70 hours per week. Reviews The organisation must ensure that the above minimum staffing levels remain under review and that at all times suitably qualified, competent and experienced persons are working in the home in such numbers as are appropriate for the health and welfare of service users. Distribution of Staff The number and distribution of nurses, care staff and ancillary staff must be reviewed at regular intervals. If at any time, the evidence indicates that there are insufficient staff of any category available to meet the assessed needs of service users, the NCSC will require DS0000019135.V363945.R01.S.doc Version 5.2 Page 5 3. 4. 5. 6. 7. 8. 9. Link House additional staffing as appropriate. Date of last inspection 15th November 2007 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 £427 to £745 per week. Link House DS0000019135.V363945.R01.S.doc Version 5.2 Page 6 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 out by one Regulation Inspector and one Regulation Manager over one day. We had the opportunity to speak with eight people who use the service, two visitors, three staff and the manager of the service. We received three surveys from relatives or visitors, eight surveys from staff and six surveys from people who use the service. The manager completed a self assessment of the service (AQAA) which was provided to the Commission. We have used all of the above information and observations made at the time of inspection to reach the judgements in this report. What the service does well: What has improved since the last inspection? Link House DS0000019135.V363945.R01.S.doc Version 5.2 Page 7 At the last inspection of the service a number of requirements were made and good progress has been made in meeting these. The Service User Guide has been updated. The record of complaints was up to date and included outcomes. The manager has applied for registration with the Commission. The record of health and safety checks has improved with evidence of weekly fire alarm tests and checks on electrical equipment having been carried out. What they could do better: One person who uses the service described how difficult it can be to move into a home. They told us that it was “hard to get accustomed to living in a home” and that you “lose your independence”. The effective use of person centred care and planning would assist people who use the service to retain some independence and could assist in reducing the sense of loss some people feel when they move in. Although some staff have made progress in providing person centred care and planning this is not consistent across the service. Care needs to be taken to make sure that where problems are identified either through assessment or observations by staff, action is taken and recorded. Where a person is complaining of pain action must be taken to relieve the pain and investigate the cause. A review of the way in which pain is assessed particularly for those people who may not be able to explain to staff needs to be done. Nursing staff need to review the way they are recording wound care to make sure that they are following advice from other professionals and to clearly show the condition of any wound. All care staff need to see the provision of activity, engagement and occupation as very important parts of their work. Improvements could be made in the environment to support people in engaging in meaningful activities. Mealtimes could be made a more social occasion and should be reviewed. The needs of individuals and opportunities for making real choices could be improved. A record of food must be kept to make sure that people who use the service are offered a varied and balanced diet. The menu should be reviewed in consultation with people who use the service. Staff training needs to be expanded to make sure that they have the skills and knowledge to meet the needs of people who use the service. Where health and safety checks show up problems a record of actions taken needs to be in place. Link House DS0000019135.V363945.R01.S.doc Version 5.2 Page 8 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.V363945.R01.S.doc Version 5.2 Page 9 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.V363945.R01.S.doc Version 5.2 Page 10 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 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 produced a Service User Guide which provides basic information on the service. Pre admission assessments are carried out to make sure that the service can meet the needs of the individual. EVIDENCE: The acting manager has made progress in updating the information available on the service. A copy of the Service User Guide is given to each person who uses the service. The Statement of Purpose is available in a number of areas around the home. The Service User Guide is produced in a basic written format and future work should focus on making the information more easily accessible. Consideration should be given to making this document more user friendly with pictures of staff, the service and the local community. Link House DS0000019135.V363945.R01.S.doc Version 5.2 Page 11 We found pre admission assessments were being carried out which assists in ensuring that the service can meet the needs of individuals. The service receives a copy of the care management assessment and or carries out their own assessment before people are admitted. Link House DS0000019135.V363945.R01.S.doc Version 5.2 Page 12 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 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 the service are provided with an individual care plan. Care plans could be improved to be more individualised and focus more on wellbeing, occupation and engagement. Information on how the needs of people who use the service will be met was not generally available. The health care needs of people who use the service are generally met and medication is well managed. Some staff feel they are not provided with up to date information on the needs of individuals in their care. This needs to be addressed. EVIDENCE: Link House DS0000019135.V363945.R01.S.doc Version 5.2 Page 13 Of the six people who use the service who completed questionnaires three people told us they “always” received the care and support they needed two people said “usually” and one person said “sometimes”. When staff were asked, through a survey, if they were given up to date information about the needs of people they support three said “always” three said “sometimes” and two said “never”. We looked at a sample of care plans on each floor of the service. We found care plans gave some good information on the personal care support people needed but little information on how this should be done. The quality of information was variable across the service. Generally care plans focused on the needs of people who use the service with limited information on the strengths of individuals along with what they could do for themselves. Care plans we looked at on the ground floor provided more detailed information on individual likes and dislikes. Staff had taken time to share information on how many pillows a person liked, whether they wanted the light on or off at night and that the person enjoyed a bath with bubble bath. The majority of care planning documents we saw were not signed by people who use the service or their representatives. Evidence needs to be available to show that consultation has taken place and that people who use the service and or their representatives have agreed the care plan. In one instance staff had noted that the family were not available to attend the care planning review. We were informed that family members for this person visited the home very regularly. Staff need to ensure that the timing of reviews meets the needs of the person using the service and or their representatives. The reviews of the care plans we saw gave little information generally stating that the care plan was ‘ongoing’. In order to provide person centred care, staff need to take note of the individual preferences of people who use the service and set out how these needs will be met. One person who uses the service told us that before they moved into the home they would take a shower at least once a day. They were now provided with a bath once a week. This person felt that this weekly bath was not sufficient for them. The routines of when and how frequently people who use the service are offered support for a bath or shower needs to be reviewed. We found keyworkers have provided good information in their reports. The daily records kept by staff were often basic and did not include clear information on actions taken or outcomes. In one instance the notes stated, on two consecutive days, that a person was complaining of back pain. We found no details of any action taken either to investigate the pain or offer pain relief. Another entry stated ‘bruises on buttock’ there were no details of who Link House DS0000019135.V363945.R01.S.doc Version 5.2 Page 14 was informed of this and it was not referred to again in the notes. Generally the daily notes are functional stating that the person was washed and dressed with no information on how the person was feeling. The daily notes do not give information on the time of each entry. Staff carry out a variety of assessments relating to the health of individuals. This assists in ensuring that people who are at risk are identified. However we found, particularly on the residential units, that where assessments showed high risk there was no information on any action taken. In one instance the information used in the risk assessment was not accurate. We noted that pain assessments were not being carried out. As research has shown significant levels of untreated pain particularly in people who are living with dementia, this should be reviewed. Staff have recorded good information on what people want to happen following their death. People who use the service have good access to other health care professionals. Staff were seen to have consulted with GP’s, district nurses and tissue viability nurses. Arrangements are in place for visits from a chiropodist, dentist and optician. Further work needs to be done on wound care records. We found records did not provide clear details to show that the advice of the tissue viability nurse had been followed. Wound maps and photographs were not in place. We looked at a sample of medication across the service. Staff are keeping good records of medication given, received into the home and returned to the pharmacy. The manager, through their own assessment of the service, stated that plans for improvements over the next 12 months include ensuring care plans contain more details of individual needs. Discussions with staff indicated that they do not have easy access to up to date nursing practice issues. The BNF, which provides information on medication, was dated 2006. Staff did not have access to clinical manuals and do not have access to the internet. Care plans did not give clear information on what were specifically nursing tasks and should not be undertaken by carers. It is of concern that certain staff did not feel confident that they were supplied with up to date information on the needs of the people they support. How information is communicated throughout the staff group needs to be reviewed. Link House DS0000019135.V363945.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): 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 using the service are given the opportunity to take part in a number of activities but this area could be improved upon. In order to develop a service that is person centred, rather than task based the home needs to continue look at how care staff could be more actively involved in social and emotional care. Helping people to have purpose and to be engaged and occupied should be a central part of the homes culture. The food provided is of satisfactory quality. Improvements could be made in the way people make choices, the variety of food and in making mealtimes a more social occasion. EVIDENCE: Two people who use the service told us, through surveys, that there were “always” activities that they could take part in. Three people said “sometimes” and one person said “usually”. Link House DS0000019135.V363945.R01.S.doc Version 5.2 Page 16 We observed an art session taking place which involved tracing. One person who uses the service told us they felt this was not appropriate for them, that it was perhaps too simple for them. This person told us that “the days are long”. We observed that when the activities coordinator came onto one of the units they brought with them a large amount of activities items and equipment but this was cleared away once the session had finished. Generally lounges, dining rooms and corridors contained very few items for people who use the service to engage with. We have recommended that staff look at providing items which people particularly those living with dementia can engage with such as; rummage boxes, pens, paper, magazines, jewellery and or hats. Consideration should be given to encouraging people to take part in meaningful daily living activities such as cooking, cleaning, polishing, helping at mealtimes or delivering post around the service. The records of activities we saw for individuals showed one or two activities a week. The activities recorded included music, manicure, bingo and aromatherapy. Staff have recorded on file a personal history for each person who uses the service. This should assist in exploring person centred activities however the information provided was brief and in one instance was not available. Consideration should be given to working with people who use the service and or their representatives to produce life history books. Where English is not the first language or where a person using the service cannot speak English we found little information on how staff are communicating with the person. We found no evidence that staff had spoken to family members to find out basic words or appropriate signage. The care plan for this person stated that they should be encouraged to come to the lounge to watch TV and that they sometimes went through magazines provided. It was not clear why this person would wish to use the lounge and there was no information on what type of magazines would be of interest. The assessment for this person stated that they listened to music but this was not included in the care plan. People who use the service told us that they could have visitors whenever they wanted and that they could meet with visitors in private. However we were told by one person using the service that it would be “difficult” to have an intimate relationship when living at the home. Issues about sexuality are not addressed by the service. We saw that church members were visiting one person using the service. When we asked people who use the service about the meals one person said they “always” liked the food and five people told us they “usually” liked the meals. One person said they would “like egg and bacon for breakfast Link House DS0000019135.V363945.R01.S.doc Version 5.2 Page 17 sometimes”. Another person said, “the food is alright but you don’t always get what you asked for”. We observed a number of people enjoying their lunch but some people who use the service clearly have difficulty or did not wish to sit at a table for the full length of a mealtime. A four week menu is produced for the service. We found the menu had been changed by catering staff without informing the manager. Improvements could be made in the way in which people are offered choices. Staff on the second floor informed us that they made the choices for people who use the service. On the first floor we were informed that choices were available for lunch, and these were made the day before, but there were no choices for suppertime. We noted that the choices offered for the next day were not on the published menu. Alternatives are available on the published menu but these were, in certain instances, the vegetarian option and on one day the alternative for fish was another type of fish. The manner in which people who use the service 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. We were informed by staff that the last meal of the day is at 5pm and that there was no food available after this time. On other units we were informed that sandwiches are available if requested. Access to food after 5pm needs to be reviewed to ensure that all of the people who use the service are offered food between the last meal of the day and breakfast. We saw no snacks or food items around the home which were easily accessible to people who use the service. Staff gave out biscuits at with morning drinks but they did not provide a plate so people had to sit with biscuits in their hand. One person who uses the service told us that they could get a plate but they would have to ask for one. We saw napkins in use on one unit but one person told us they had to ask for a napkin. In order to make mealtimes a more social occasion consideration should be given to implementing protected mealtimes where all staff within the service and relatives should they wish, join with people who use the service at the main meal of the day. This could provide opportunities to increase independence with the use of serving dishes and drinks on tables for people to help themselves. More staff would be available to encourage socialising and support people who need some assistance with eating. Link House DS0000019135.V363945.R01.S.doc Version 5.2 Page 18 We found no evidence that the cultural needs of individuals in relation to food were being addressed by the service. In one instance we were informed by staff that family members brought in food. We are aware that family members may enjoy providing items of food but the service should ensure that at times where this is not available appropriate food is made available. Catering staff should consult with families on the type of meals preferred. We were informed by staff that a record of food was not being kept. The manager stated, through their own assessment of the service, that improvements could be made in providing more activities that residents like and obtaining more information from relatives and family with regard to social profiles. The improvements quoted over the last twelve months include the home now having two activity coordinators who organise outings, film shows and other daily activities. The plans for improvement over the next twelve months included setting up coffee mornings, care playing leagues and quizzes with the local community and other homes. Link House DS0000019135.V363945.R01.S.doc Version 5.2 Page 19 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. Concerns or complaints about the service are listened to and acted upon. Access to the complaints procedure needs to be improved. The manager is aware of the procedures to be followed should there be any allegation or suspicion of abuse. EVIDENCE: Two of the six people who use the service who responded to our survey told us that they did not know how to make a complaint. Two of the three relatives who responded did not know how to make 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 at time of reviews and in residents meetings. Systems are in place to record any complaint. We saw three complaints had been recorded along with details of the investigation and outcomes. Of these two complaints had been upheld and one partly upheld. This indicates that the management listens to people and learns from any previous mistakes or omissions. Policies and procedures in relation to safeguarding people are in place. At the time of this visit information on how many staff had completed training on Link House DS0000019135.V363945.R01.S.doc Version 5.2 Page 20 safeguarding people was not easily available. The manager will be providing this information to the Commission in the near future. Link House DS0000019135.V363945.R01.S.doc Version 5.2 Page 21 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, 24 & 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 and bathrooms could be improved. EVIDENCE: We found the building to be well maintained, clean and fresh. People who use the service told us that they felt the home was always kept clean. We observed that people had been encouraged to personalise their own rooms by bringing with them items of furniture, pictures, photographs and other personal possessions. Individuals informed us “I like my room” and “it’s very nice in here, I can sit quietly”. Link House DS0000019135.V363945.R01.S.doc Version 5.2 Page 22 The manager informed us that two bedrooms had been redecorated over the last twelve months and plans for the next twelve months included installing new dishwashers and providing new crockery, tablecloths and napkins. The service has a well maintained enclosed garden to the rear. People who live on the ground floor were seen to go in and out of the garden when they wished. Staff on the first and second floor told us that accessing the garden for people on these floors was less frequent. We observed that the lounge, dining room and corridors particularly on the second floor did not provide people with dementia anything to engage. Corridors did not contain any items that might assist people in locating their own room and the décor could be improved to distinguish bedroom doors. The notice board on this unit was not being used to give information to the people who lived there and there were a significant amount of notices which related to either staff or visitors. This does not add to a homely environment. Bathrooms were seen to be very clean and tidy but did have a clinical appearance which again does not add to a homely environment or provide a good space for relaxation. Consideration should be given to adapting the environment to meet the needs of people with dementia in line with current good practice. Link House DS0000019135.V363945.R01.S.doc Version 5.2 Page 23 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 & 30 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. Enough staff are available but routines need to be reviewed to make sure they are person centred not task centred. Staff are provided with good opportunities for training. The training programme needs to be reviewed to ensure that the training provided is in line with the needs of people using the service. EVIDENCE: Five people who use the service who completed surveys told us that staff listen and act on what they say. One person felt that staff did not listen to them. People also told us that staff are always or usually available when they need them. We received comments from people who use the service and visitors about the use of agency staff. People felt that new staff did not always know about routines and one person who uses the service told us that this was “difficult” as they had to tell new staff what support they needed and how they would like them to do it. We are aware that the manager is continuing to try and recruit more permanent staff. Link House DS0000019135.V363945.R01.S.doc Version 5.2 Page 24 We received positive comments about the staff. One person told us staff “give friendship and companionship” that made their relative “flourish since moving in” and that “staff treat people as individuals” Visitors told us that staff made them feel welcome and that they were able to join in activities if they wished. We observed staff providing care in a gentle and considerate manner. We saw a number of staff on each unit taking time to sit and talk with people who use the service. However we did also observe staff sitting together talking in a lounge. We feel this is a missed opportunity to engage with people who use the service. We were unable to look at staff files at this inspection as they were being reorganised. These will be examined at the next inspection. Staff told us they had good opportunities for training and staff we spoke to were in the process of completing NVQ level 3 and 2. We were unable to access the record of staff files at the time of this visit. The manager has agreed to forward to us a copy of the training record. This was not received in time to be included in this report. This issue will be looked at during the next inspection of the service. Staff informed us that they had received training in dementia care. However these staff had only been provided with one days training. As a significant number of people who use the service are living with dementia we recommend that staff are provided with more detailed training on dementia care particularly around engaging people in meaningful activities. We would also recommend that staff are provided with additional training on person centred care and planning which would assist in improving their knowledge and skills to support people who use the service. As noted previously in this 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. Staff told us they felt well supported by senior staff and that they had regular contact with the manager. Link House DS0000019135.V363945.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, 33 & 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 make regular checks on the service to ensure the health and safety of people who use the service, staff and visitors. Staff are not always recording actions taken when problems are found on these checks. The acting manager understands person centred planning and thinking and plans to further implement this in practice to improve outcomes for people who use the service. EVIDENCE: Since this home opened there have been a significant amount of managers in post. The acting manager is in the process of being registered by the Commission. Link House DS0000019135.V363945.R01.S.doc Version 5.2 Page 26 In order to consult with people who use the service residents meetings are held. We saw the minutes for one meeting. Staff have recorded comments from people who use the service along with what they would like to do. To ensure that these comments or requests are acted upon staff should record actions and review previous minutes at the next meeting. The organisation has its own quality monitoring systems which include surveys for people who use the service and other people involved. The manager informed us that surveys had been sent out but she had not received feedback on the results from the head office as yet. The record of health and safety checks were generally well maintained. Fire alarms are tested each week, regular fire drills are carried out and regular maintenance checks are completed. The checks on portable electrical equipment, which were not in place at the last key inspection, have now been carried out. We noted that checks on the temperature of hot water were not being carried out on a regular basis in certain areas of the home. In addition it was noted in February and April of this year that the temperature of the water to one bath was low. We saw no evidence of actions taken to fix this problem. We also noted that records show no hot water in four areas with no information on what action was taken. Link House DS0000019135.V363945.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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 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 3 X 3 STAFFING Standard No Score 27 3 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X X 2 Link House DS0000019135.V363945.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(b)(c) Requirement 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 information on how the needs and wishes of individuals will be met. Care plans need to be compiled and reviewed in consultation with the person using the service and or their representative. This will assist in making sure that the care provided meets the needs and wishes of individuals. To ensure the health and welfare of people who use the service a review of the way staff are informed of the individual needs of people they are supporting must be carried out. Staff must record actions taken where assessments or observations indicate risks or problems with the health or welfare of individuals. This will assist in making sure that risks are reduced and no DS0000019135.V363945.R01.S.doc Timescale for action 01/08/08 2 OP7 12(1) 01/08/08 3 OP8 13(4) 01/08/08 Link House Version 5.2 Page 29 4 OP8 12(1) one is left with untreated or investigated pain. To make sure that the health 01/08/08 and welfare of residents is protected a review of the manner in which pain is assessed and addressed must be carried out. To ensure the health and welfare 01/08/08 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. To ensure the health of people who use the service a clear record of food must be kept. 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. 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. 01/08/08 5 OP8 17(1)(a) Schedule 3 (k) 6 OP15 17(2) Schedule 4 (13) 16(2)(i) 7. OP38 13(4) To ensure the health and safety of people who use the service staff must record actions taken where checks show a problem with access to or the temperature of hot water. 20/07/08 Link House DS0000019135.V363945.R01.S.doc Version 5.2 Page 30 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 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. 3 OP7 The choices available for people who use the service on the frequency and timing of baths or showers needs to be reviewed. Staff should make sure that they include the time they make entries in the daily notes. Care staff should see the provision of social and emotional care as important parts of their work. Care staff could look at how people could be more involved in the daily life of the home. This could be helping with preparation of meals, serving food and drink, helping with laundry or cleaning. Consideration should be given to providing key staff with training on activities based care. 6 OP12 OP19 Link House 2 OP7 4 5 OP7 OP12 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 DS0000019135.V363945.R01.S.doc Version 5.2 Page 31 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. 7 OP15 A review of mealtimes should be carried out to look at improving choice, presentation, access to menus and access to snacks and drinks. Staff should review how mealtimes could be made a more social occasion. 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. 8 9 OP15 OP30 Link House DS0000019135.V363945.R01.S.doc Version 5.2 Page 32 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.V363945.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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