CARE HOMES FOR OLDER PEOPLE
Linksway Linksway Nursing Home 17 Douglas Avenue Exmouth Devon EX8 2EY Lead Inspector
Michelle Oliver Unannounced Inspection 22nd November 2005 14:00h 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 Linksway DS0000059789.V259382.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. Linksway DS0000059789.V259382.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Linksway Address Linksway Nursing Home 17 Douglas Avenue Exmouth Devon EX8 2EY 01395 263677 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) Alextour Limited Mr Nicholas Thomas Higgins Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Linksway DS0000059789.V259382.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Notice of Proposal to Grant Registration for staffing/environmental conditions of registration issued 10/7/98 25th May 2005 Date of last inspection Brief Description of the Service: Linksway is a detached property standing in extensive grounds, situated in a residential area of Exmouth. The home provides accommodation for up to 24 people over retirement age. Service user’s accommodation is on the ground and first floor with a passenger lift between the two floors. Some rooms have ensuite facilities, some including a bath. There is a lounge on the ground floor. A second lounge/ diner on the first floor can also be used as a function room by residents and relatives. There is ample parking on site. Linksway DS0000059789.V259382.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on Tuesday 22nd November 2005 over a period of six and a half hours. Not all of the standards were assessed at this inspection. Those not assessed met the standard at the last inspection. Both providers were present during the inspection and positive discussion took place in relation to their commitment to continued improvement of the quality of care given at Linksway. Eight residents and six members of staff were spoken to and were helpful and Informative. The inspector looked around parts of the building and a number of records were inspected including residents’ plans of care, medication records and staff training and recruitment records. What the service does well: What has improved since the last inspection?
Six requirements and two recommendations were made at the last inspection. Four requirements and one recommendation have been met. Four staff recruitment files were looked at. All included the information required to meet the standard and to protect residents living at the home by the home’s robust recruitment policy. This includes proof of identity, two references and a police check. Staff have been provided with relevant up to date training to enable them to identify and report any poor practice at the home and training in the correct
Linksway DS0000059789.V259382.R01.S.doc Version 5.0 Page 6 procedure for assisting and moving residents with limited mobility living at Linksway. Staff said that they now receive formal one to one supervision at least 6 times a year. They found this useful as a means of identifying individual training needs, their plans for their ongoing development at the home and to discuss the general improvements in the service they offer as part of the care team at Linksway. The manager is developing a programme of training for all staff. 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. Linksway DS0000059789.V259382.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Linksway DS0000059789.V259382.R01.S.doc Version 5.0 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 the following standard(s): None of these standards were inspected at this visit. All met the standard at the last inspection. EVIDENCE: Linksway DS0000059789.V259382.R01.S.doc Version 5.0 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 the following standard(s): 7 & 9. Limited progress has been made on improving arrangements to ensure that the health and social care needs of residents are identified and met. Some recording of drugs administration is not being attended to. Attention is needed to ensure that records are accurate in order to minimise risks for residents at Linksway. EVIDENCE: At the last inspection the care planning procedure was being reviewed and an improved format was underway. Three residents plans of care were looked at during this visit. Individual plans of care were basic and little progress has been made on the requirement to ensure that all aspects of health, personal and social care needs are identified and planned for. Daily entries into case records had been made but gave little indication of the actual care given. This was particularly evident for a resident who described an injury that resulted in bruising. There was no record of a risk assessment, associated plan or preventative measures taken as a result of the incident. Other residents spoken to were able to describe care needs that had not been recorded in their care plans. Discussion with staff suggested that most care needs were being
Linksway DS0000059789.V259382.R01.S.doc Version 5.0 Page 10 addressed even though there was a lack of clear plans and guidance. This approach is dependent on staff memory and good verbal communication skills. The home’s medication policy has not been expanded to include all aspects of how medication is dealt with at the home as recommended at the last inspection. Medication records are inconsistent. Gaps were noted on the medication administration records. It was not clear whether the medication had been given and not signed for or not given. This is a potentially putting residents at risk. Not all medication is recorded when received at the home. Staff procedures when administering medication are also inconsistent. Discrepancies in some medication were noted. No explanation was available for this. The provider said that this matter would be investigated. There was an apparent discrepancy between the totals in the Controlled Drugs register and the contents of the cupboard. The explanation for this was that they had ceased to be recorded in the register, as they were not classed as controlled drugs. It is essential to ensure that on transfer of medication from the register the quantity must be transferred out of the stock in the register. Linksway DS0000059789.V259382.R01.S.doc Version 5.0 Page 11 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 & 15 Social activities are reasonably managed for the residents at Linksway, however further consideration needs to be given to developing activities for residents who lack capacity. EVIDENCE: Care staff take responsibility for arranging activities and provided a weekly programme of activities. Most of the residents choose to stay in their rooms. Many said that afternoons are usually quiet and that they are told about any activities but had not been asked what activities they would like to have at the home. The majority of the residents at Linksway are happy and content to spend time in their private rooms although they are informed of all activities taking place at the home. Staff said that they spend time with residents in their rooms encouraging and assisting them to undertake interests that they have or by simply being there so that residents can talk. A resident said that the home “ certainly lives up to my expectations and more”. Some residents spoke of not being able to take part in some activities due to individual limitations and that there did not seem to be anything that was “particularly suitable” for them. They said they were often bored. All the residents said how good the food is and how much they enjoy their meals. Residents and staff said that the quality and presentation of meals had improved since the last inspection. The cook is aware of residents’ likes and dislikes. A resident said that they would prefer to have a main meal in the
Linksway DS0000059789.V259382.R01.S.doc Version 5.0 Page 12 evening and not at lunchtime. This was discussed with staff who said that they were not aware of this as she had not discussed it with them. The cook keeps a basic plan of meals but this did not provide sufficient detail to determine whether the diet is satisfactory in relation to nutrition and of any special diets prepared for individual residents. This was discussed with the cook and provider who agreed that a comprehensive menu would be compiled. Residents do not see a menu, are not told what the main meal is but are given a choice for evening meal. However, the cook said that if a resident chose not to have a particular meal an alternative would be available. Linksway DS0000059789.V259382.R01.S.doc Version 5.0 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 the following standard(s): 18 Staff have a good knowledge and understanding of the forms of abuse. There is nothing to suggest that residents at Linksway are anything but well cared for and protected. EVIDENCE: Since it was required at the last inspection staff have received training in the protection of vulnerable adults. All said that they would not hesitate to challenge and report any poor practice. Linksway DS0000059789.V259382.R01.S.doc Version 5.0 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 the following standard(s): 22 & 26. Minor adaptations to the call system are needed to ensure that residents are able to call for assistance at all times. The cleanliness and standard of hygiene is good and provides a reasonably safe environment for residents at the home. EVIDENCE: A nurse call system is in place throughout the home with the exception of the residents lounge. A call point is available but is not currently functioning. This potentially puts residents at risk in particular those with reduced mobility and those with limited cognitive capacity. Staff said that they walk past the lounge often. A relative said that they were concerned about lengthy, unsupervised periods that residents spent in the lounge. When asked about residents access to a call bell in the lounge when it is functioning a member of staff said that one resident would alert staff to other residents needs when necessary. Consideration needs to be given to this issue to ensure that residents’ needs are met.
Linksway DS0000059789.V259382.R01.S.doc Version 5.0 Page 15 All areas of the home were cleaned to a high standard and there were no unpleasant odours. Sluicing facilities have been improved by replacing a non mechanical with a mechanical sluice in the laundry. Although staff described strict procedures that are followed, with regard to sluicing, there is a risk of cross infection to vulnerable people e.g. clean garments hanging up in the laundry along side the sluice/washing machine. Staff were able to describe good general infection control measures. Hand washing facilities are available throughout the home and staff carry hand sanitising gel with them at all times. Residents said that the home is always clean and pleasant. Linksway DS0000059789.V259382.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): 28, 29 &30. Residents benefit from having a reasonably stable staff team who a good understanding of their needs. Specialist relevant training needs to be central to a planned training programme in order to support staff in meeting residents’ needs. The procedures for the recruitment of staff are consistent and robust therefore provide safeguards for the protection of people living at the home. EVIDENCE: The majority of the staff have worked at the home for a number of years. Staff were aware of residents needs although these were not consistently recorded in individual care plans. [Refer to standard 7] Residents said that staff were all very kind and that they felt that they were in safe hands at all times. Currently no members of staff are undertaking NVQ training although five have expressed an interest in doing so. A staff member has put their NVQ4 training “on hold”. Staff said that the provider was reviewing NVQ training. There was nothing to suggest that residents were not well cared for at Linksway at the time of this visit. Recruitment procedures have improved, as required, since the last inspection. Three staff recruitment files were looked at. All included relevant documentation e.g. proof of identity, two references, birth certificate and police checks. However, there was no record of dates staff commenced employment at the home, hours for which they are employed or the position they hold at the home. When asked staff said that they had not received a
Linksway DS0000059789.V259382.R01.S.doc Version 5.0 Page 17 copy of the General Social Care Council codes and were therefore unaware of the code of conduct and practice set. Newly appointed staff confirmed that they had received an induction period. This consisted of shadowing senior members of staff, reading policies and procedures and getting to know the residents. Induction records were unavailable. There was no evidence of staff receiving foundation training within the first 6 months of employment. Some relevant training has been provided since the last inspection with several staff attending Adult Protection training, Manual Handling and tissue viability. Staff said that most staff had received first aid training but this was due to be updated as the training was undertaken in 2002. Staff also said that they would be more able to meet individual residents’ needs if they received specific training e.g. dementia care and care of the dying. Linksway DS0000059789.V259382.R01.S.doc Version 5.0 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 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): Residents receive care in a safe environment. EVIDENCE: This standard was not fully assessed at this visit. Requirements from the last inspection were assessed. Staff have received training in infection control procedures and manual handling as required at the last inspection. Formal staff supervision has been implemented since required at the last inspection. Linksway DS0000059789.V259382.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 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x x x x 2 x x x 3 STAFFING Standard No Score 27 x 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x 3 x 3 Linksway DS0000059789.V259382.R01.S.doc Version 5.0 Page 20 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 Requirement Timescale for action 2 OP9 13[2] The registered person shall , after consultation with the service user, or a representative of his, prepare a written plan as to how the service users needs 22/02/05 in respect of his health and welfare are to be met.[ This is the 2nd time the requirement has been made. The previous timescale has not been met] The registered person shall make arrangements for the recording, handling and safe administration 22/12/05 of medicines received into the care home. of medicines received into the care home. Linksway DS0000059789.V259382.R01.S.doc Version 5.0 Page 21 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 OP9 OP12 Good Practice Recommendations The homes policy should be expanded to include how medication is to be managed at the home. All service users are given opportunities for stimulation through leisure and recreational activities in and outside the home which suit their needs, particular consideration given to people with visual, hearing or dual sensory impairment or those with physical disabilities. A menu, changed regularly, offering a choice of meals is given, read or explained to residents. Records are kept of food provided for residents in sufficient detail to determine whether the diet is satisfactory in relation to nutrition and of any special diets prepared for individual residents. It is recommended that an accessible call system be made available for communal areas, with particular regard to residents with reduced mobility or capacity. Policies and procedures are considered for the prevention of the risk of cross infection when laundered clothes are hanging in the laundry alongside sluice/ washing machine. 3. 4. OP15 OP15 5. 6 OP22 OP26 Linksway DS0000059789.V259382.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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