Inspection on 30/11/05 for Link House

This inspection was carried out on 30th November 2005.

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 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 24/05/05

Link House 19/10/04

Link House 25/05/04

Link House 09/01/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Link House Link House 15 Blenheim Road Raynes Park London SW20 9BA Lead Inspector Emma Dove Unannounced Inspection 30th November 2005 10:50 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.V271283.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V271283.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Link House Address Link House 15 Blenheim Road Raynes Park London SW20 9BA 020 8545 4920 020 8332 1044 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) Central & Cecil Housing Trust Mrs Marie Rose 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.V271283.R01.S.doc Version 5.0 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.V271283.R01.S.doc Version 5.0 Page 5 3. 4. 5. 6. 7. 8. 9. Link House additional staffing as appropriate. Date of last inspection 13/06/05 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 residents are currently residing at the home with one resident 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 DS0000019135.V271283.R01.S.doc Version 5.0 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over the course of eight hours, one day by two regulatory inspectors. The inspection focussed on the first and second floor and consisted of examination of records, inspection of communal areas, three residents bedrooms, talking to residents, staff and the registered manager. The inspectors had the opportunity to speak with fourteen residents and six members of staff. What the service does well: What has improved since the last inspection? What they could do better: Care plans must include more detail to ensure staff can meet individual’s needs. Evidence of residents and relative’s involvement in the care planning process should be available. Records of wounds must be more detailed, including changes in the wound size, measurements and include the dressings used. Daily recording should be related to the care plans and be factual. Consideration should be given to the call bell sounding on the floor where it is ringing, rather than all three floors. A more detailed activities programme should be developed to meet resident’s needs. Records of staff training should be more easily accessible to evidence sessions and courses individuals have attended. Staff must receive regular supervision from a senior member of staff with records maintained. Link House DS0000019135.V271283.R01.S.doc Version 5.0 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. Link House DS0000019135.V271283.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Link House DS0000019135.V271283.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Prospective residents have access to appropriate information to make an informed decision regarding moving into the home. EVIDENCE: The Statement of Purpose and Service Users Guide to the home contain information to assist prospective residents in choosing to move into the home. These documents have not changed since the last inspection. Link House DS0000019135.V271283.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 7, 8, 9 & 10 Care planning systems require further improvements to fully identify resident’s needs and ensure that they can be fully met by staff. Resident’s health care needs are compromised by the recording systems in place at the home. Resident’s health and safety is protected by medication policies and practices within the home. EVIDENCE: Care plans examined varied in the detail that they contained, not all care plans include individuals full needs and how they should be met by staff. Needs assessments had been completed, a detailed profile sheet was in place but not fully completed in all case files examined. Some care plans had been reviewed monthly, however some care plans for individual residents had not been reviewed since March 2005 and October 2005. Two care plans included evidence that relatives are involved and issues have been discussed. The manager has instigated an internal audit of care plans, which identified some areas which need improving in resident’s individual case files. However the areas which required completing, reviewing or updating had not been addressed in files examined. Residents are all registered with a GP, staff reported that the GP visits the home weekly and as required. In one case file no records were included of Link House DS0000019135.V271283.R01.S.doc Version 5.0 Page 11 visits from the GP, which indicate that the resident had not seen a doctor for thirteen months. This does not meet resident’s health needs. Staff reported that no residents had pressure sores, however examination of two care plans identified a pressure sore on one resident’s heel. Another case file indicated that the resident had a wound. No specific care plan was in place for one resident who had a wound, details of which were not recorded on the Waterlow score which had been completed the previous week. Wound charts were not completed in full and did not include measurements, type of dressing used and any changes in the wound. The daily recording in one case file identified a skin abrasion, however no record of an accident was in place and no accident form had been completed. When ‘cotsides’ were in place there was no evidence that consent forms had been completed. The manager said that there is a document to be completed which will be in a file. On one unit, residents weights were recorded with clear details of intervention when weight loss is significant. However on another unit residents files indicated that weight had not been recorded on a monthly basis, which again does not fully meet resident’s health needs. One resident had been recently reassessed as needing nursing care and the home were awaiting reports for ‘panel’ at the local authority prior to moving the individual to an appropriate bed within the home. When an individual residents needs change there should be a process in place to ensure these changed needs can be met at the home. Appropriate medication policies and practices are in place at the home. Medication is suitably stored, records are maintained of medication received at the home and those returned to the pharmacy. The manager has implemented regular medication audits which identify areas which need improving, this is a good initiative. Staff were observed maintaining residents privacy and dignity. All bedrooms are fitted with a doorbell which staff use prior to entering a residents bedroom. One resident confirmed that staff ring the doorbell before entering their room. Link House DS0000019135.V271283.R01.S.doc Version 5.0 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 the following standard(s): 12, 14 & 15 Residents have access to a few regular activities and some outings. Resident’s dietary requirements are met by the varied menu provided at the home. EVIDENCE: During the course of the inspection residents were observed to be watching television, listening to the radio, speaking with staff and speaking with visitors. One member of staff has been organising activities at the home for a short period of time which staff reported was very helpful. A number of residents went out for a pub lunch during the course of this inspection and staff and residents reported that a further trip was due to take place the following week. Regular sessions with an artist and aromatherapist continue on a regular basis. The home provides a varied menu with vegetarian alternatives available. Resident’s comments regarding meals included ‘the food is good’, ‘the food is usually this good’ and ‘this isn’t what I ordered’. One resident reported that they spoke with the chef daily to organise their meal and that they are satisfied with this arrangement. Clear evidence was available that residents on one unit had chosen their meals the previous day. On one unit staff were not clear regarding how residents chose their meals. Mealtime was observed to be unhurried and well managed for residents. Residents may take meals in the dining room or in their bedrooms. Staff Link House DS0000019135.V271283.R01.S.doc Version 5.0 Page 13 reported that they are available to offer assistance with eating to residents as required. Link House DS0000019135.V271283.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 18 Residents are protected by policies regarding the protection of vulnerable adults, however it is not clear if staff have completed relevant training. EVIDENCE: The organisation has policies and procedures regarding the protection of vulnerable adults with a copy of the placing authority policy available at the home. It was not clear from records if staff have completed training in the protection of vulnerable adults. Link House DS0000019135.V271283.R01.S.doc Version 5.0 Page 15 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 the following standard(s): 19 Residents live in a safe environment which is maintained to a satisfactory standard. EVIDENCE: The home was purpose built and meets the needs of current residents. The home is separated into three units, one on each floor of the home. Each unit has a separate lounge and dining areas, a choice of bathroom or shower room and all bedrooms are single. Link House DS0000019135.V271283.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 & 30 Resident’s needs are met by both long-standing and new members of staff. Staffing levels are in line with those set at the time of registration. The recruitment process ensures the protection of residents. Staff have access to training programmes at the home and through the organisation. EVIDENCE: The published staffing rota identified two members of staff on duty on the ground floor and three members of staff on duty on the top floor in the morning with two members of staff coming on duty to assist at lunchtime. One nurse and two members of staff were on duty in the afternoon on the first floor. The manager and deputy manager were available at the home in addition to these staff with some staff out with residents on the outing. Staff were reported to be ‘good’, ‘helpful’, ‘kind’ ‘smiling and happy’ and ‘responsive when I call’. Examination of staff files identified that they contained the required information. New staff confirmed that they had been interviewed and received the information they required when commencing employment at the home. Staff training records indicated that one nurse has completed training in fire safety and this must be completed for the other nurses employed at the home. One nurse reported that they had completed training in infection control and is due to complete training in wound care. Link House DS0000019135.V271283.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35, 36, 38 Resident’s financial interests are safeguarded by policies and practices at the home. Staff have not been receiving regular supervision. Residents and staffs health and safety is protected by policies and procedures in place, however some recording practices compromise individuals safety. EVIDENCE: The manager has been away from the home for three months and this was evident in a number of areas, particularly internal audits, which had not been completed and actioned as required and generally with staff meetings and staff supervision not being completed at regular intervals. This was discussed with the manager who is aware and has developed an action plan to get systems back on track. The home holds finances for residents, which are securely stored with appropriate records maintained. No issues were raised regarding residents finances. Link House DS0000019135.V271283.R01.S.doc Version 5.0 Page 18 Fire safety records identified that the fire alarm has been tested weekly by staff with one exception in July 2005. Regular fire drills have taken place with records maintained of staff in attendance and the training session which followed for staff. Link House DS0000019135.V271283.R01.S.doc Version 5.0 Page 19 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 3 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X X X X X X STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 2 X 2 Link House DS0000019135.V271283.R01.S.doc Version 5.0 Page 20 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 OP7 Regulation 15 (1 & 2) Requirement The registered person must ensure that care plans include details so staff can meet residents assessed needs. (previous timescales of 16/12/04 & 19/07/05 not met) 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. (previous timescales of 16/12/04 & 19/07/05 not met) The registered person must ensure that consent is sought when ‘cotsides’ are used. The registered person must ensure that residents weight is monitored with records maintained to include actions taken when significant weight loss or gain is noted. The registered person must ensure that staff are employed to provide a variety of appropriate activities and outings DS0000019135.V271283.R01.S.doc Timescale for action 30/01/06 2. OP8 15 (1 & 2) 30/01/06 3. 4. OP8 OP8 12 (1) a 12 (1) a 30/01/06 30/01/06 5. OP12 12(1)&16 (2)n 30/01/06 Link House Version 5.0 Page 21 6. OP30 18(1) c 7. OP33 26(1,2,3, 4&5) 8. OP36 18(2) 9. OP38 23 (4) c for residents. (previous timescale of 19/07/05 not met) The registered person must ensure that all staff complete training in fire safety and for nurses to receive appropriate training. (previous timescale of 30/07/05 not met) 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. (previous timescale of 19/07/05 not met) The registered person must ensure that all staff receive regular supervision. (previous timescales of 16/12/04 & 19/07/05 not met) The registered person must ensure that the fire alarm is tested weekly. 30/01/06 30/01/06 30/01/06 16/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP19 OP30 Good Practice Recommendations Consideration should be given to the call bell only sounding on the floor it is being used and the response times must be checked regularly. Staff training records should be easily accessible and indicate training individuals have completed. Link House DS0000019135.V271283.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London 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 DS0000019135.V271283.R01.S.doc Version 5.0 Page 23 - 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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