Inspection on 27/10/06 for Link House

This inspection was carried out on 27th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Link House 15/11/05

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 27th October 2006 11.55 Link House DS0000002378.V315524.R01.S.doc Version 5.2 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.V315524.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 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.V315524.R01.S.doc Version 5.2 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.V315524.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15 November 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 is registered to accommodate up to eight service users with learning disabilities, who require personal care. The fees are £500.00 - £1500.00 per week depending on the assessed needs of each client. Link House DS0000002378.V315524.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection site visit was carried out over 5 hours and took any previous information held by CSCI, about Link House into account. The site inspection consisted of case tracking a sample of the resident’s records and assessing their care. The inspector spoke with all the residents, the manager and the operations manager as well as two members of staff. Parts of the home were seen during the inspection, and a review of a sample of the records was also included. The people who live at the home have stated a preference that the inspector uses the term ‘client/s’ as a collective term throughout this report. What the service does well: What has improved since the last inspection? The staff have changed the way they give medication and this is safer. The patio used to be uneven and could cause trips. This has been repaired and the outside walls have been painted. Link House DS0000002378.V315524.R01.S.doc Version 5.2 Page 6 What they could do better: The people who provide the service to the clients need to make sure there are enough staff . The clients are not getting enough support to take part in activities that suit them during the day. This includes being able to learn new things and going to places where they can learn outside the home. The whole group does some activities because there are not enough staff even though the activities may not suit all the clients. The people who provide the service to the clients need to make sure that every one who moves to the home will know that this is the right home for them and that the staff can support them. The written plans about each person ( Care Plans) should help the staff to support each client in a way that they would want and need. The care plans should give the staff guidance in how to support the clients to take risks, but also stay as safe as possible. The staff smoke in parts of the home that are used by the clients who do not smoke. This goes against the homes policy, and the people who provide the service must consider the health of all the clients and staff. Any rules in the home should be agreed by all the clients and not made by the acting manager or staff. The clients have their movements restricted in the home for part of a day and the people who provide the service agree that this is not ideal. This happens when staff from a college help the clients and those from another home with living skills in this home. They say that this is the only way that the college can manage, but the clients should not have their movements restricted in their own home. The clients like the acting manager but they have not been registered. The people who provide the service must ensure that they have a registered manager at the home to lead the staff team in supporting the clients. The staff did try to communicate with all the clients but they need further training to communicate effectively. Link House DS0000002378.V315524.R01.S.doc Version 5.2 Page 7 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 DS0000002378.V315524.R01.S.doc Version 5.2 Page 8 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.V315524.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The manager is not adequately assessing prospective clients prior to them moving to the home, therefore the clients cannot be assured that the service can meet their needs. EVIDENCE: One resident recently moved from another home in the same group. An admissions form had been completed, with a brief history, however no pre admission assessment had taken place. An interim assessment had been carried out after the move to confirm that the move was permanent. The social worker and the staff were pleased with the progress that the client had made after the move, but it was not clear why the move had been made and how it would benefit the client. Link House DS0000002378.V315524.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans do not guide staff about how to provide support, or manage risks. The staff are supporting the clients to make decisions. EVIDENCE: The clients are aware of their care plans and they are involved in reviewing part of the plan with their key worker, they also said that they had choices about their personal care. These included aspects such as when they are supported with maintaining their personal hygiene. The care plans did contain information about each clients needs but they did not give information about how the staff need to provide that support. One care plan did not contain information about how the staff should support a client with challenging behaviour, even though this was identified as ‘sever’ on a previous document. The risk assessments identified what the risk was, but not what the staff could do to manage that risk. Link House DS0000002378.V315524.R01.S.doc Version 5.2 Page 11 One member of staff was supporting a client to make a choice and decisions about their clothing, this was done in an enabling and caring way. Link House DS0000002378.V315524.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The clients are not offered staff support to participate in meaningful daytime learning opportunities, and some of their activities have been restricted. The clients are supported to access appropriate and enjoyable leisure activities, and to maintain contact with their family and friends. EVIDENCE: The clients told the inspector about recent social activities and holidays. The regular reports from the provider also record the client’s leisure opportunities, which are varied. Client’s access local amenities and take part in events, they also get together with friends for celebrations and parties. The evidence from previous reports and from the regular reports from the provider show that the clients are supported to maintain links with their Link House DS0000002378.V315524.R01.S.doc Version 5.2 Page 13 families and friends, they also spoke positively about contact during the inspection. Each person has a weekly activity sheet, but these activities were not always happening. The manager had filled in a form to say that people had taken part in activities before the time of day they were scheduled for, when in fact they had not completed these. The clients were supported to participate in a DVD quiz during the inspection, however the acting manager explained that only two of the clients would benefit form this activity. They explained that there weren’t enough staff to provide the separate activities that had been identified. The operations manager said that the plans needed to be reviewed as they contained too many activities. People are provided with half a day a week life skills training in the home and for the other half of that day they are restricted in their own home as clients form another home use part of the house for their training. The operations manager stated that they had sought alternatives and the situation was not ideal. When the opportunities centre closed, the inspectors were assured that there would be suitable replacement education and employment opportunities, and that staffing would be available to facilitate these. There has been a reduction in the learning opportunities, and useful occupation for the clients that did attend the centre. The operational manager stated that the centre would reopen in January 2007 on a more social basis, offering a chance to get together with friends and participate in leisure opportunities. The clients said ‘we like all the staff, they are all patient and kind. They said that ’ the staff knock on our doors and don’t shout at us’. Two clients said that there was a rule that they are not allowed to watch T.V before 4p.m. The manager said this was to discourage them watching too much, but no one would be stopped if they switched it on during the day. The clients clearly believed this was a rule. The clients said they like the food and they get to choose what they want at the client meetings. They participate in keeping their home clean and in cooking some meals. Link House DS0000002378.V315524.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. The clients are supported to maintain their health and personal hygiene. The medication is stored and administered satisfactorily. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The client’s health care needs were being met and the staff were aware of these needs. A client attended an appointment on the day of the inspection and details of treatments or diagnosis were recorded. The staff spoke about how they support the clients with their personal hygiene to meet individual needs. Although the staff had an understanding of individual care needs the care plans did not detail how the clients prefer to be supported. The staff have received medication administration training and the administration has been changed to a safer system. Link House DS0000002378.V315524.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good Complaints are dealt with according to the policy and the clients are satisfied that they will be listened to and supported. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The clients said they knew how to complain and they would go to the manager. The complaints procedure is displayed in the home in symbol form and the staff are confident in dealing with complaints. The operational manager gave and example of a recent complaint and how this had been resolved. The pre inspection questionnaire recorded that staff had received abuse awareness training in January 06, and the organisation has procedures to follow if staff suspect abuse. Link House DS0000002378.V315524.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good The clients like their home, which is suitable and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The clients have access to all areas of their home and they feel safe and confident using the communal and private areas. The clients were pleased with their garden where the large patio has been repaired. This makes the surface more even and therefore safer. The clients have been involved in planting containers and keeping the area tidy. The clients all take part in household tasks to keep their home clean. Link House DS0000002378.V315524.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 Quality in this outcome area is adequate The staff are recruited safely and trained for their roles. There are not enough staff to meet all of the daily programmes that have been identified for individual clients. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rota’s were included in the pre inspection questionnaire. They demonstrate there are usually two staff on each daytime shift to support eight clients. There are adequate staff to meet every day needs but not to enable the daily programmes for each client to happen reliably and effectively. The pre inspection questionnaire details the training that the staff have participated in, this is varied and suitable for their roles. Previous inspections show that the registered providers follow their own recruitment procedures and that all the required information is in the staff files. Link House DS0000002378.V315524.R01.S.doc Version 5.2 Page 18 Link House DS0000002378.V315524.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is poor The acting manager has been in post for a year without applying for registration. The clients are confident that the staff will listen to them. The registered providers manage the home safely, but are not protecting the clients from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager has been in post for almost a year without applying for registration. This does not comply with regulations. Although the staff said that the manager was effective CSCI have not assessed their suitability within the regulations to manage a registered home. The manager said they were waiting for funding to start the registered managers award. The operations manager said it was an oversight. Link House DS0000002378.V315524.R01.S.doc Version 5.2 Page 20 During the site visit it was observed that the majority of the interactions between the staff and the clients were positive. One client tried to communicate with the acting manager and the acting manager appeared to understand some of the signs, however when this became difficult no further attempts were made and the client left the office. It appeared that some signs that the client often uses were repeated frequently. The registered providers do conduct regular quality surveys and the clients meet regularly with the staff. Examples were given when changes have been made as a result of the clients expressing their views. The staff smoke in the office and the activities room, and the acting manger stated this was with the agreement of the clients. The registered providers policy states that ‘the home is no smoking’. The operational manager said this was a contentious issue and the policy was new. The pre inspection questionnaire recorded dates when safety checks were carried out. The registered providers maintenance and safety procedures have been seen at previous inspections. Link House DS0000002378.V315524.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 2 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 2 12 2 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 X 3 X X 2 X Link House DS0000002378.V315524.R01.S.doc Version 5.2 Page 22 NO 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 YA2 YA3 Regulation Requirement Timescale for action 30/12/06 2 YA11 YA12 3 YA33 4 YA37 5 YA42 14(1)(a)(b)(c)(d) The registered person must ensure that all service users moving to the home have a needs assessment prior to the move and that the person is assured in writing that the service can meet their needs. 12(1)(b) The registered person must ensure that the clients are supported to take part in valuable daytime activities, learning opportunities including daily living skills, or employment. 18(1)(a) The registered person must ensure that there are enough staff to support the clients with appropriate and useful daytime occupation. 8(1)(a) The registered person must ensure that they are not carrying on a registered care home without a registered manager. 13(4)(a)(b)(c) The registered person must ensure that they protect the health of all the service users and staff. 30/12/06 30/01/07 30/12/06 30/12/06 Link House DS0000002378.V315524.R01.S.doc Version 5.2 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 Refer to Standard YA6 Good Practice Recommendations The registered person should ensure that care plans reflect the client’s wishes, preferences and aspirations. They should also guide the staff in how they will meet individual needs. The registered person should ensure that risk taking enables personal development and that staff are given guidance in the care plans to minimise risks. The registered person should ensure that the clients understand their rights and responsibilities and that restrictive rules are reviewed with the clients. The registered provider should ensure that the client’s preferences regarding health and personal care are detailed and used as a guide for staff delivering the support. The registered person should ensure that the staff have the training to be able to communicate effectively with all with the clients. 2 3 4 YA9 YA16 YA19 5 YA37 Link House DS0000002378.V315524.R01.S.doc Version 5.2 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: 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 DS0000002378.V315524.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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