Inspection on 24/05/05 for Link House

This inspection was carried out on 24th May 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 but made no statutory requirements on the home.

Other inspections for this house

Link House 10/03/09

Link House 20/05/08

Link House 10/05/07

Link House 04/05/06

Link House 30/11/05

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Link House 15 Blenheim Road Raynes Park London SW20 9BA Lead Inspector Emma Dove Unannounced Tuesday 24 May 2005 07:15 am th 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 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 G54-G04 S19135 Link House V230830 240505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Link House Address 15 Blenheim Road Raynes Park London SW20 9BA 020 8545 4920 020 8332 1044 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Central & Cecil Miss Marie Rose CRH Care Home with Nursing 52 Category(ies) of DE Dementia (18) registration, with number OP Old Age (34) of places Link House G54-G04 S19135 Link House V230830 240505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Nursing Places 2. Nursing Unit 1st Floor - Qualified Staff 3. Nursing Unit 1st Floor - Care staff 4. Dementia Care Unit 2nd Floor - Care Staff 5. Residential Unit Ground FLoor - Care Staff 6. Management 7. Ancillary Staff 8. Reviews 9. Distribution of Staff Date of last inspection 19/10/04 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. Fifty-two residents are currently residing at the home with two residents in hospital. 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. Residents have access to enclosed gardens to the rear and side of the home. Each floor at the home is serviced by a lift. The home 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. Link House G54-G04 S19135 Link House V230830 240505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over the course of eleven hours by two regulation inspectors. A pharmacy inspector visited the home on the 1st June 2005. The inspection consisted of examination of records, inspection of communal areas of the home and one residents bedroom, talking to residents, visitors, staff and the registered manager. The inspectors spoke with six residents, one visitor and seven members of staff. What the service does well: What has improved since the last inspection? The Statement of Purpose and Service Users Guide to the home have been updated to include the required information. Progress has been made with the development of care plans and risk assessments. The ceiling in the first floor dining room has been repaired and the carpet in one bedroom on the second floor has been replaced. The manager has registered with the CSCI. Progress has been made with the frequency of staff meetings for each unit and the whole staff team. A realistic staff supervision programme has been developed. These issues were all Requirements from last inspection. Other developments at the home have included: the provision of staff photographs on each unit; a format for three to six monthly reviews of residents care needs with reviews taking place for some residents; a checklist and audit for medication administration and storage with records maintained and clear details of actions taken; the rear garden and entrance have been developed with new plants, which is more appropriate for residents and Link House G54-G04 S19135 Link House V230830 240505 Stage 4.doc Version 1.30 Page 6 welcoming for visitors and a new senior position has been provided at the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Link House G54-G04 S19135 Link House V230830 240505 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Link House G54-G04 S19135 Link House V230830 240505 Stage 4.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3 & 4 Prospective residents have access to information enabling them to make an informed choice regarding moving into the home. Residents needs are assessed prior to admission, ensuring the home is appropriate and that their needs will be met. EVIDENCE: The Statement of Purpose and Service Users Guide to the home have been updated since the last inspection to include details of the new manager. Assessments are carried out prior to admission to the home ensuring the home can meet prospective residents needs. Care plans are developed from the assessments. One resident said ‘it’s ok living here’ and one relative reported ‘a marked improvement in their relatives condition since admission to the home’. Link House G54-G04 S19135 Link House V230830 240505 Stage 4.doc Version 1.30 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 Care plans are in place and have improved since the last inspection. To ensure that residents individual needs and wishes are met, the information available must be more detailed. Records are not maintained consistently to ensure residents health needs are met. The home has good arrangements for ordering, storage, recording and auditing of medication and has access to a pharmacist for advice. All residents had their medication administered appropriately and as directed unless recorded otherwise. Recommendations relating to medication were made for two issues that did not affect the health or welfare of any residents. EVIDENCE: Six care plans were examined. Progress has been made in developing the care plans however information does not include a full medical and social history. Care plans did not consistently include details of residents or relatives involvement in the process. Care plans have been reviewed with records maintained. A three/six month review had been carried out for one resident, this is a good practice to ensure changes in residents needs are reported and care plans changed if required. Daily records for one resident noted restless behaviour, with no indication of intervention from medical or health professionals. Daily records for another Link House G54-G04 S19135 Link House V230830 240505 Stage 4.doc Version 1.30 Page 10 resident did not include details of dressings used on a wound, when the dressings were changed and whether the wound was improving or getting worse. This does not promote residents health and welfare and does not ensure their needs are fully met. Risk assessments are in place and have been developed from the assessment process. Records of residents weight have not been maintained consistently. The record for bathing and showering was not completed for one resident when the personal hygiene care plan noted that the individual has a bath every week. The bathing record for one resident indicated that the individual has had four baths in nine weeks. Records must be maintained consistently to ensure residents needs are fully met. The written policies and procedures were found to be adequate on the last inspection and were not reviewed on this visit. All medications administered by staff along with the records relating to receipt, storage, administration and disposal of medication were examined. The person in charge of each unit was interviewed, the audit records on all units reviewed and medication counted and compared to the amount that should be in stock for thirteen residents where medication had not been dispensed in the monitored dosage system. From these observations and discussions, all medication was stored securely, all records had been completed accurately and provided evidence that all medication had been administered correctly, changes to medication clearly identified that medication was stored and administered safely, regular audits had been performed and any necessary action taken. Only staff trained and assessed as competent by a senior member of staff administer medication. In addition to the necessary records, risk assessments were seen describing the risks and actions for residents refusing medication and regular three-six monthly reviews were performed detailing any visits by health personnel and any changes that were made. Large amounts of medication were returned in April 2005 for one resident. No reason was recorded. The person in charge of the unit stated that the extra supply had come from hospital and was not required. One eye preparation was not labelled with the date when it was opened. A new supply is obtained every four weeks so the item is changed before the expiry period is reached. All other preparations with a short expiry period once opened were dated when opened. Neither of these issues affected the health or welfare if the resident. Residents did not raise issues regarding privacy and dignity, staff assist residents with personal care in bedrooms and bathrooms and doors were observed to be closed. The inspectors raised issues regarding residents dignity and respect with the manager following observations made at lunch time when: two residents were given plastic aprons to wear while two other residents were given appropriate fabric clothing protectors to wear during lunch. One member of staff was observed assisting two residents with eating, this does not promote residents welfare. Staff did not respond to one residents requests to go to their room or comments regarding not wanting to eat, however when a resident asked for a drink, staff supplied a drink Link House G54-G04 S19135 Link House V230830 240505 Stage 4.doc Version 1.30 Page 11 immediately. Staff were observed clearing plates away from the table without checking if residents had eaten sufficient. It is recommended that mealtimes are reviewed to ensure residents receive appropriate support in a dignified and respectful manner when eating. Staff could take meals with residents to encourage conversation and discussions between residents. Link House G54-G04 S19135 Link House V230830 240505 Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 13 Residents have access to three regular activities arranged at the home. Residents are encouraged to maintain contact with family and friends. EVIDENCE: A new recording system is in place for activities residents have taken part in. Regular activities at the home include a film show, a visit by an aromatherapist and an art class each week. In addition, a television and music equipment are available on each unit at the home. Residents were observed to be watching television and reading the paper during the course of the inspection. The leisure and activities should be developed further with consideration given to employing a member of staff to ensure residents have access to a wider range of appropriate activities to meet their needs. Residents can have telephones in their bedrooms or can access a portable public phone, which is in the entrance of the home but can be moved to individuals bedrooms. Visitors are welcome at the home and were seen to be on the first floor during the course of the inspection. Representatives from the Catholic Church and Church of England attend the home once a month enabling residents to continue religious observance. Link House G54-G04 S19135 Link House V230830 240505 Stage 4.doc Version 1.30 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 A complaints procedure is in place, which is accessible to residents. Records are retained of complaints. EVIDENCE: The home has a complaints policy, which is included in the Statement of Purpose and Service Users Guide to the home. Residents confirmed that they know how to make a complaint. No complaints have been received at the home since the last inspection. The CSCI has received two complaints since October 2004, which were regarding staff supervision and support which was not substantiated and one relative was not informed of a residents illness which was substantiated. Link House G54-G04 S19135 Link House V230830 240505 Stage 4.doc Version 1.30 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20 & 26 Residents live in a safe and well-maintained environment. Furnishings and fittings are of a good quality. EVIDENCE: The home was purpose built and is suitable for its purpose. Residents were observed to be comfortable in the lounge and dining areas and bedrooms have been personalised with the individuals pictures and belongings. One resident said ‘my room if fine, not as big as home but I’m getting used to it’. The double-glazing in one bedroom on the second floor was half filled with water and the windowsill requires replacing. The handrails in the corridors have been filled down to prevent the risk of accidents, these now need repainting. Other areas of the home were found to be clean and well maintained. A programme of redecoration was not seen and this should be completed to ensure the environment is maintained at a good level for residents. Staff and residents have worked hard with planting and preparing hanging baskets at the front and rear of the home, giving residents a lovely Link House G54-G04 S19135 Link House V230830 240505 Stage 4.doc Version 1.30 Page 15 garden to sit in and look out over and making the front of the home welcoming to visitors. Immediate Requirements were made at the last inspection regarding the ceiling in the dining room on the first floor being repaired and the carpet in one bedroom on the second floor being replaced. These Requirements have been completed. Link House G54-G04 S19135 Link House V230830 240505 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 Staff morale was high amongst staff spoken to, staffing levels are in line with those set at the time of registration. Residents benefit from a mix of longstanding and new staff. Staff have access to a training and development programme. EVIDENCE: The manager reported six vacant positions at the home which is an improvement since the last inspection, with on-going recruitment drives within the Organisation and at the home. Staff were described as ‘ok’, ‘good’ and ‘helpful’. One member of staff reported poor staffing levels at night. This issue needs to be kept under review to ensure residents needs are met. A training and development programme is available to all staff. Records are maintained of training courses staff have attended, however this record is confusing to read and should be clearly presented. Over half of the staff team have completed NVQ training as recommended in the National Minimum Standards for Older People. Evidence was not available to confirm that staff have completed training in fire safety, this does not promote residents welfare. A format has been completed for fire training, which needs to be implemented. Fire drills have taken place every month with records maintained of staff in attendance. Staff files examined contained information required with the exception of one new member of staff who was completing their induction at the home and no Link House G54-G04 S19135 Link House V230830 240505 Stage 4.doc Version 1.30 Page 17 information was available. This does not protect residents welfare and is not in line with the Care Homes Regulations 2001. Link House G54-G04 S19135 Link House V230830 240505 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36 & 38 Residents have opportunities to voice their opinions regarding the services provided at the home. Staff supervision should be more frequent to ensure good quality of care and to enable staff to develop their professional standards. Residents health and welfare are protected by policies and practices at the home. EVIDENCE: A Requirement was made at the last inspection for the manager to register with the CSCI, this has been completed. Regular residents and relatives meetings are held with minutes available to those unable to attend. In addition, residents needs are reviewed regularly. This allows residents and their relatives opportunities to comment on the services provided and be involved in the day-to-day running of the home. Link House G54-G04 S19135 Link House V230830 240505 Stage 4.doc Version 1.30 Page 19 A Requirement was made at the last inspection regarding the monthly visits completed by the registered person take place unannounced. Evidence was not available confirming this. Copies of reports carried out in August and September 2004 and March 2005 have been sent to the CSCI, these visits must be monthly to be in line with the Care Homes Regulations 2001. Good progress is been made on ensuring staff meetings take place. This ensures staff are kept up to date with relevant matters to do with the home and the individual unit and promotes communication which in turn ensures residents needs are met. A supervision structure is in place although records indicate that not all staff receive supervision at the required intervals. This does not allow for staff members individual development or the opportunity for management checks on care practices at the home. It is noted that progress has been made in the number of supervision sessions which have taken place. Staff records indicated that appraisals have been completed. The fire policy is displayed and the fire alarm system is checked and tested as required. Regular fire drills have taken place. Requirements made at the last inspection regarding: the CSCI being notified of incidents affecting residents health and welfare; one fridge being replaced; food in fridges on each unit being labelled with the date it was opened and the electrical supply test being available have been complied with. Other issues relating to health and safety were in good order at the last inspection of the home. Link House G54-G04 S19135 Link House V230830 240505 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 4 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x COMPLAINTS AND PROTECTION 2 3 x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 2 x x 2 x 3 Link House G54-G04 S19135 Link House V230830 240505 Stage 4.doc Version 1.30 Page 21 YES Are there any outstanding requirements from the last inspection? 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 7 Regulation 15 (1 & 2) Requirement The registered person must ensure that care plans include details so staff can meet residents assessed needs. (the timescale of 16/12/04 not met) The registered person must ensure that the assessment includes residents medical history. The registered person must ensure that detailed information is recorded regarding pressure sores and wounds, including the dressings used, when dressings are changed and whether the wound is improving or getting worse. (the timescale of 16/12/04 not met) The registered person must ensure that accurate records are maintained of the frequency residents are offered and take a bath or a shower. The registered person must ensure that residents dignity is maintained at all times and that staff receive training in how to assist residents with eating in an appropriate manner. The registered person must ensure that staff are employed Timescale for action 19/07/05 2. 8 14 (2) 19/07/05 3. 8 15 (1 & 2) 19/07/05 4. 8 17 19/07/05 5. 10 12 (1) a & (2) 19/07/05 6. 12 12 (1) & 16 (2) n 19/07/05 Page 22 Link House G54-G04 S19135 Link House V230830 240505 Stage 4.doc Version 1.30 7. 19 23 (2) b 8. 29 19 (1) & Schedule 2 18 (1) c 9. 30 10. 33 26 (1, 2, 3, 4 & 5) 11. 36 18 (2) to provide a variety of appropriate activities and outings for residents. The registered person must ensure that the double glazing and windowsill in one bedroom on the second floor are repaired or replaced. The registered person must ensure that information regarding staff is available at the home when they have commenced employment. The registered person must ensure that all staff complete training in fire safety and for nurses to receive appropriate training. The registered person must ensure that an unannounced visit is carried out every month with a report made available at the home and a copy sent to the CSCI. The registered person must ensure that all staff receive regular supervision. (the timescale of 16/12/04 not met) 19/07/05 19/07/05 19/07/05 19/07/05 19/07/05 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. 3. Refer to Standard 9 9 27 Good Practice Recommendations It is recommended that all eye preparations are labelled with the date when opened. It is recommended that the reason for the disposal be recorded when large amounts of medication are returned. It is recommended that the staffing levels are reviewed in relation to the assessed needs of residents. Link House G54-G04 S19135 Link House V230830 240505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Ground Floor - CSCI 41-47 Hartfield Road Wimbledon SW19 3RG 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. Extracts may not be used or reproduced without the express permission of CSCI Link House G54-G04 S19135 Link House V230830 240505 Stage 4.doc Version 1.30 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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