Inspection on 23/11/07 for Linksway

This inspection was carried out on 23rd November 2007.

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

Linksway 26/11/08

Linksway 13/06/06

Linksway 22/11/05

Linksway 11/01/05

Linksway 14/07/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Linksway Linksway Nursing Home 17 Douglas Avenue Exmouth Devon EX8 2EY Lead Inspector Ms Rachel Fleet Unannounced Inspection 23rd November 2007 9.25am 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.V315753.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Linksway Address Linksway Nursing Home 17 Douglas Avenue Exmouth Devon EX8 2EY 01395 273677 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) amberlinks@btinternet.com Alextour Limited Vacancy Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Notice of Proposal to Grant Registration for staffing/environmental conditions of registration issued 10/7/98 13th June 2006 Date of last inspection Brief Description of the Service: Linksway is a detached property with extensive grounds, in a residential area of Exmouth. The home has accommodation for up to 24 people over retirement age, on ground and first floors. The second floor of the building is unoccupied and not used as part of the care home. There is ramp access to the home, and a passenger lift between the two floors. On the first floor, some rooms are accessed via a small flight of steps, which is part-covered with metal ramps for assisted wheelchair use. Eight of the eighteen bedrooms have en suite toilet and wash facilities; the others have a washbasin within the bedroom. Some bedrooms can be used for double occupancy if people wish to share a room. The home has bathing and shower facilities accessible to people with mobility difficulties. There is no dining room specifically, but some people eat their meals in the ground floor lounge at the entrance to the home. A large room currently being used in part as an office, on the first floor, can also be used as a function room on request. There is a parking area outside the front entrance. A copy of the Commission for Social Care’s (CSCI) most recent inspection report is available through the person in charge. At the time of this inspection, fees were £580 - £840 a week. Fees vary according to individuals’ needs and the size of the room (including if one person wants sole use of a double room). Services not included in this fee include hairdressing, chiropody, newspapers, magazines and incontinence aids. Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place as part of our usual inspection programme. There were fifteen people living at the home during our visit, which lasted 12 hours over two days (Friday 23 & Monday 26 November 2007). The first day of our visit was unannounced. An agency nurse was in charge, with no senior staff representing the registered provider easily able to attend the home that day. So we returned for a second day to complete the inspection, when Sally Moyse (Nursing Director), the administrator for the home, and Mr John Towers, (Responsible Individual and Director) of Alextour Ltd. made themselves available to assist us. Efforts are being made to recruit a manager for the home. We were accompanied for part of our first day by someone acting in the capacity of an ‘expert by experience’, arranged through ‘Help The Aged’. An ‘expert by experience’ is a person who, because of their experience of using services, and/or ways of communicating, visits a service with us to help us get a better picture of what it is like to live in or use the service. They spoke with people around the home during the four hours they spent there. A CSCI questionnaire on the home (the Annual Quality Assurance Assessment, or AQAA) had been returned prior to our visit, completed by Sally Moyse in the absence of a home manager. This included some assessment of what they assess they do well, and plans for improvement. We had also sent surveys to various groups of people. Nine surveys were returned from people living at the home, seven of who had been helped to complete the survey by different staff from the home (one also having a relative present). Four were returned from relatives or supporters. Seven were returned from health and social care professionals connected with people living at the home. Four care staff surveys were returned. The inspection included ‘case-tracking’ of three people – including people new to the home, people with more complex needs (including mental health needs), men and women, and people we wished to follow up as a result of information from surveys or in relation to issues raised at the last inspection, to see if certain issues had been addressed. This involved looking into peoples’ care in more detail by meeting with them, checking their care records and other documentation relating to them (medication sheets, etc.), talking with staff, and observation of care they received. Over the two days, views were obtained from at least nine people who lived at the home, two relatives or supporters and seven staff (including care staff, ancillary staff, and agency staff). We visited three people who were unable to tell us their views. We observed staff interactions with the individuals they Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 6 cared for, looked around the home, and looked at records. These included records relating to staff, catering, health and safety, and quality assurance. We ended the visit by discussing our findings with Sally Moyse and Mr Towers. We carried out a random inspection on 30 May 2007, to check that requirements made at the inspection in June 2006 in relation to health, personal care and safety had been met. We found six of seven requirements had not yet been met. Information gained from all these sources and from communication about the home since the last full inspection (in June 2006) is included in this report. What the service does well: What has improved since the last inspection? Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 7 The home confirms in writing to each prospective resident that it is suitable for meeting their health and welfare needs, on the basis of pre-admission assessments it carries out. People are now consulted about the use of bed rails on their bed, and the potential usage is risk assessed to ensure it is appropriate and safe. A rolling menu is made available to people living at the home, so they can have some choice and variety in their diet. Peoples’ freshly laundered clothes remain so, a sluice in the laundry having been removed. A system for reviewing and improving the quality of care provided at the home has been commenced, which ensure people living at the home are involved in its running. Management arrangements have been improved, although there is no home manager, so staff have some direction and leadership. What they could do better: A professional suggested, “Higher staffing - but overall an excellent nursing home”. A visitor also suggested staffing be improved, feeling their spouse was left in bed too long, only able to sit out when family were able to visit and stay with them. A staff member felt ongoing improvements were making the home a nice place to work. Another suggested, “Training and full staffing, even if they use agency”. Others suggested team work could be better, staffing levels, more activities and time to spend with people - not having to rush them. One felt people who needed help to eat should be eating later, saying ‘they are eating too early at 11.30am.” We thought if people had more information about the home, they could make a better decision about whether it will be the right home for them. Introducing more thorough and person-centred care planning, which involves people more fully as individuals, would promote their dignity and welfare. Improvements to care records and medication systems would also ensure each person receives the care they need to promote their safety and health. More attention to how individuals spend their free time and various matters relating to mealtimes would help to meet some peoples’ very different needs, which the home is beginning to try to address. Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 8 Providing people with their own lockable facility would help them to have some choice and control, regarding treasured items or valuables. Better complaints procedures and related practices would reassure people that their concerns would be acted on. Some improvements are already underway, but staffing arrangements must be further reviewed to ensure people can receive care they need or want in a timely way, from safe and competent staff. Long term management arrangements, more health and safety checks, and fuller quality assurance processes must be established at the home, thus ensuring the home is run so as to protect and promote the welfare and best interest of people living or working there. 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. Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3. The home does not provide intermediate care. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home gets good information about prospective residents, and can thus confirm appropriately with individuals whether or not they can meet their care needs. However, people do not get enough information about the home, so they cannot make a fully informed decision about whether it will be the right home for them. EVIDENCE: One person said their relative viewed the home twice before choosing it on their behalf. Families had similarly helped other people. Two surveys of nine from people living at the home felt they didn’t get enough information about the home before moving in. The Statement of Purpose and Service User Guide we were shown did not have accurate or sufficient information about the home to fully inform people about Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 11 certain matters. For example, one said there are ‘arrangements’ in place for aspects of daily life or for meeting certain needs, rather than informing people about what they can actually expect from the service. Senior staff were aware of a need to update the information. We looked at records for three people who had moved into the home since the last inspection. We saw the home had sent them a letter before they moved in, confirming the home could meet their needs as identified in assessments carried out previously by senior staff from the home. Information gathered before people were admitted was detailed, personalised and comprehensive. Social Services care managers had provided information about some peoples’ needs, as had other professionals who were caring for people when they began looking for a care home. Staff said they were informed about people ahead of their admission, thus being able to prepare their room according to their identified needs, etc. We were told a staff member is allocated to greet them, help them unpack, and complete an inventory of their property. There was evidence that two of the people and/or their legal representative had been given contracts or a statement of terms and conditions, by the home. Where a third person did not think they had been given a contract and there was no evidence of this, the home thought it had been sent to the nextof-kin and they had not returned it yet. We suggested a record was kept in such circumstances, to clarify the situation. Between them, the confirmation letter and contract informed people of the room they were to occupy and their weekly fee, amongst other things. Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People receive health and personal care that is generally provided respectfully. However, people will benefit from more person-centred care planning that is being introduced at the home, that involves them more fully as individuals, in order to promote their dignity and welfare. Some improvements to care records and medication systems would ensure each person receives the care and treatment they need to promote their safety and health. EVIDENCE: People told us that staff had discussed their care with them. One said they were told if their care plan was changed, and knew that medication changes were recorded in it. We saw people or their representative had signed pages in their care plans, including risk assessments for rails put on their bed. New care planning documentation was being completed that would guide staff to more person-centred care. Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 13 The care plans we saw for three people covered their various types of needs. Each plan had generally been personalised to reflect peoples’ individuality and preferences about the support they got. Staff we spoke with appeared to know individuals, their needs and preferences relatively well. However, we did not see individual goals or targets indicated - in nutrition care plans, for example, although staff were completing daily intake charts. Some staff were not sure how information they recorded on the diet/fluid intake charts was actually used. Charts were not mentioned much in daily notes, with few evaluations or totals of intake, to show if the person had had sufficient; some notes were not specific enough to evaluate this properly - for example, stating ‘Encouraged fluids’. There were monthly evaluations of other care that were usefully detailed, on the whole, showing how effectively the planned care had met peoples’ needs. However, care plans were not always updated or amended in the light of these or information in daily notes – such as when peoples’ weight changed, or a community-based professional visited and gave advice about someone’s care. Five of nine surveys from people living at the home felt that they always or usually got the support they needed or that staff were available when needed. Four were less positive on these points. Two supporters of people living at the home told us the people they visited always looked cared for. And most people we met had had their appearance well attended to. Someone remaining in bed during our visit had their position changed regularly. Some people we asked told us they felt their health needs were well attended to. Care notes, conversations, training records and professionals’ surveys showed advice and information was sought (and followed) from a range of health professionals. People had had recent eye checks by a visiting optician, for example. Specialist community nurses and an occupational therapist had visited the home to see people and advise staff on their care. A visitor told us they had seen nursing staff deal well with emergencies such as choking, remaining calm and reassuring to those present. We were told that staff, when communicating with someone with cognitive problems due to dementia, allowed them time to respond. We saw staff had regularly completed assessments for risks of pressure sores, malnutrition and falls. One professional told us the home had recently replaced and upgraded much of the equipment they used to prevent pressure sores. A pressure-relieving mattress was at the wrong weight setting for the person using it, which we brought to staff attention. Two people we spoke with reported they had pain, which care notes showed staff had been consulted GPs about. We discussed whether pain assessment tools might help assessment of the problems the two were still experiencing. Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 14 We queried that pain was leading one person to request a limb was kept off a pressure-relieving mattress that might help to heal the painful part. It appeared no specialist advice had been sought about this. Wound care records included measurement and description of wounds, which is necessary to evaluate the effectiveness of any treatment. It was recorded in two different places, and we discussed that cross-referencing might ensure staff using the care plans got all the information needed. The statement of terms and conditions we were shown said people could selfmedicate if they wished, and the medication policy said lockable facilities were provided in such circumstances. Pre-admission information about one person said they were self-medicating then; staff have been administering their medication since admission, with no evidence that this had been discussed with the person. Another person said they would like to self-medicate all their medication, at present just being responsible for some of it; they did not have a lockable facility. A staff member said the person was not deemed safe to self-administer in their previous care setting. But no risk assessment had been completed by the home when the person was admitted, to review the situation in a new setting and confirm the person was able to self-administer the items they had. One person said one member of staff actually put medication into the person’s mouth, which the person felt was well intentioned but was not necessary. A visitor felt they were not informed enough about additional medications given to their relative. Conversation with someone showed staff were monitoring the effect of changes to medication made by a doctor. We saw one handwritten change to a medication chart that had not been signed and dated to verify the correctness of the change. A tube of eyedrops had not been dated when opened. A pot in a drug cupboard, labelled ‘drugs for disposal’, contained a mix of tablets – making it hard to account for the different tablets disposed of; only one person signed records kept of larger quantities of medication disposed of. There was detailed information about homely remedies that might be given to certain individuals, signed by a GP, but this had not been reviewed for two years (despite a note saying it was to be reviewed annually). People we asked said staff respected their privacy when they were in the bath for example. Toilets and bathrooms had privacy locks on them. We heard staff knock on doors before entering bedrooms. Someone who spent a lot of time sitting with someone who lived at the home confirmed staff were mindful of maintaining confidentiality in such circumstances (where staff often worked in the presence of someone who was not a member of staff). They also said that staff preserved the person’s dignity in these circumstances, when personal Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 15 care was needed. Staff told us that certain people preferred female staff only to help with personal care. Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 – 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Daily life, social activity and mealtimes at the home do not yet meet the needs of those with more diverse wants or preferences, although the home is trying to address this, whilst also enabling people to benefit from supportive relationships with family and friends. EVIDENCE: Good information had been obtained about some peoples’ specific interests, on their admission to the home. This was used to plan social care under a heading of ‘Work/play’. Senior staff said the new person-centred care plans would have a more appropriate title. Life stories had not been obtained about two of the three people we case-tracked. We noted one had complex needs that were challenging the service’s ability to meet their needs. The home has been trying to recruit an Activities Co-ordinator. Five of nine surveys from people living at the home said there were activities arranged by the home that they could always or usually take part in; the other four said there were sometimes or never such activities. Someone sitting in their room said they chose to remain there, and they did not get bored. Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 17 Another person quite new to the home (also in their room) told us there were ‘socials’ about every three weeks, a church minister came monthly to hold a service or give communion, and residents’ meetings were held occasionally. However, some ladies were clearly not interested in “fortnightly sing-songs around the piano” or “kicking a ball” (for armchair exercises); one suggested an informal talk from a visiting speaker might be enjoyable. One person said there used to be a library at the home, with large print books they could read, but this had now gone. There was little evidence from people we spoke with of any outings other than with friends or family. Regarding recreation or occupation, one person’s care notes for six weeks prior to our visit had one reference to a visitor, and one to a shopping trip, but otherwise said ‘mobilising in wheelchair’. Staff told us another person who stayed in their room had been taken to the shops by staff once, to try to give them an interesting experience. One staff member said they thought people got bored – particularly those with poor mobility and those who didn’t want to socialise much. A group of staff are trying to address this by holding ladies’ and men’s’ ‘pamper’ days, along with Christmas-related craft and other activities (hoping to include shopping trips to see the Christmas lights), in the time until Christmas. Someone said they would be glad if staff could help them write cards. The Director said the person was always helped with this, which he himself had done last Christmas. We saw the statement of terms and conditions said visiting was unrestricted. People told us their visitors were made to feel welcome, and visitors we spoke with were very happy with the home. We saw someone’s care plan included checking the person wanted to see visitors before taking them to them. Senior staff confirmed that a cordless phone we saw set up in a corridor was available for anyone to use. Bedrooms were personalised with people’s possessions, ornaments, etc. Lockable facilities are not routinely provided in bedrooms, but are provided on request. We discussed that the home could be more proactive, so people can more easily keep treasured or valued possessions themselves without having to give them to others for safekeeping. People told us that most staff let them stay up as long as they liked in the evenings, and helped them up early if they wished to be up. Two surveys from people living at the home said staff did not listen and act on what they said. The new care records being introduced included reminders about peoples’ rights. Someone had made an advance directive, and this was reflected well in their care plan. We were told that people had a choice of meal at lunchtime, and that they had weekly menus in their rooms. We also saw one displayed in the entrance hall. However, it was not very clear to read, and we found that people with visual impairments did not have menus, staff offering them choices verbally instead. Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 18 One such person said they would like to have a menu they could read for themselves, which senior staff said they would address. People we spoke with did not have any complaints about the different meals of the day, or the quality or quantity of food they were given, other than one person who said they were given too much. The expert by experience found, while they did not meet anyone who was overly enthusiastic about the meals, meals were judged to be “alright”. We saw fresh fruit in the kitchen. Whole (i.e. not semi-skimmed) milk is used regularly, which is in line with good practice guidance for care of older people. Staff said people had a choice at lunchtime in as much as staff did not bring them the meal shown on the menu if it was known to be something they did not like, or if someone did not want the lunch presented to them; an alternative would be discussed in such cases. A choice was actually offered in advance of the evening meal, so that those meals could be prepared ahead of time. There was a list in the kitchen showing peoples’ individual dietary requirements (identifying people with diabetes or food allergies, etc.), though identifying people by room number and not by name. And there was information on individuals’ likes and dislikes. One person told us they didn’t like certain foods but were still given them; some staff were unaware of this, and agreed to remedy matters. The menu rotates on a four-weekly basis, although we were told that while the full-time cook has been absent, meals have varied from the planned ones because ingredients needed have not been available on the day. It was not clear where these changes were recorded. One person said they had been told they could have a bowl of fruit in their room, an agreement reflected in their care plan; staff were aware of this but said the fruit had been provided only occasionally. Another person said they had been told to ask for what they liked, and asked for bacon but hadn’t yet had it. One person was buying some food items themselves because they didn’t like what was provided. Once senior staff were made aware of this, they agreed to look into this, to see if the home might provide the items. They said they would review the type of tea the home uses, on hearing that three people told us it could be better/more flavoursome. There is no dining room, with meals taken in the lounge by a small number of people, or in bedrooms. The benefits of mealtimes being a social occasion and celebration of special occasions are therefore limited. We were told of plans to create a first floor dining room. Three staff commented that mealtimes for people needing help were not appropriate. One said, ‘They are eating (lunch) too early at 11.30am’. Another Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 19 staff member said their last meal of the day was served at 4.30pm, and this then left too long a gap until breakfast at 8.30am the next morning. Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. More robust complaints procedures would reassure people that they are listened to and their concerns are acted on. The home uses a variety of practices that safeguard people and their interests, to try to protect them from abuse. EVIDENCE: People who we asked said they would tell the former matron who still worked at the home, or other staff, if they had a complaint. Surveys from people living at the home showed one person did not feel their views were not responded to appropriately, and this was discussed with the Nursing Director and the Responsible Individual for the service. Three of four relatives’ surveys said they always got an appropriate response to any concerns they raised, with one replying ‘sometimes’. Surveys from professionals gave similar findings. There was one complaint recorded in the home’s Complaints log (relating to answering of call bells), with detail of action taken to resolve it. Someone told us they had made a complaint about a staff matter, which senior staff had addressed, with partial resolution of the issue. This complaint was not recorded in the log; senior staff said they had not had time to record it yet. Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 21 Two other people living at the home also told us of similar concerns. Staff were concerned that we were hearing opinions from someone they felt was very negative at the time; but after recognising that more than one person was raising the same issue, senior staff agreed to follow up the matter again. We discussed that staff should be careful to continue to listen to everything people told them. Since the last main inspection we have not received any complaints about the home, but someone contacted us concerned they were able to walk into the home unchallenged, and found no manager, and no dining room. We arranged for Mr Towers the Director to contact them to discuss these matters. On our visit, we found the front door locked, and saw staff going to answer the door regularly. A permanent manager is still being sought, with the Nursing Director currently overseeing the home. The timescale for creating a dining room is not yet known. The complaints procedure displayed in the entrance hall appropriately included that people could contact Social Services or us. It did not give contact details, or timescales for the home’s response to any complaint. Although not all staff had had training on safeguarding people in the last year, those we spoke with were able to describe bad practice and abusive practices. They also knew appropriate agencies outside of the home they could report concerns to, if they had any that they did not wish to report to their employer. The home had obtained detailed, clear information about Power of Attorney arrangements for one person. We saw the statement of terms and conditions gave information about the limits of personal insurance provided by the home. The supporter of one person said the home had declined to fit bedrails to the person’s bed, explaining to the family that an assessment had shown it might be cause more harm than benefit. One of three people we case-tracked had a completed inventory of their property. Senior staff agreed to address this, so inventories were completed for everyone. Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from generally well-kept, clean and pleasant accommodation. EVIDENCE: On our visit, we found the standard of decoration was very good. Generally, everything looked clean and fresh – a usual state according to surveys we received - and well maintained. Bedrooms were attractive, most having a sunny aspect and furnished with peoples’ own furniture. The ‘expert by experience’ felt the over-all impression was one of ‘quality’. Staff said if people wanted certain furnishings, etc. in their rooms when they moved in, these were provided (window blinds, for example), and also that repairs were dealt with quickly. An issue with someone’s call bell, identified during our visit, had been dealt with before we left. Someone sitting in their room was seated so they could see out of their window. They had their call bell to hand. They liked their room, and said the Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 23 heating, lighting and hot water supply was satisfactory, as did other people. One person, however, told us there was the hot water supply to their bedroom was not so good. They said they were told it was because of the number of baths taken elsewhere in the building, which a staff member confirmed. We saw some of the rooms had high ceilings. Two people we spoke with said the bedrooms could be a bit dim when using the ceiling lights, one of these being in the room of someone at risk of falling. The Director agreed to address these issues immediately he was made aware of them. The garden has a number of seats. A visitor said there were wheelchairaccessible areas. There were no unpleasant odours apart from in one bedroom where there was a slight lingering odour, which we informed senior staff of. Disinfecting hand gels, disposable gloves and aprons were available around the home. A visitor confirmed staff used these when going to undertake personal care. Staff we asked were able to describe appropriate procedures for preventing crossinfection, although one person noted not all staff removed disposable gloves/aprons before leaving the room where they had been wearing them as they should. Some staff are yet to attend infection control training. We were told that repair of the laundry flooring, damaged following the recent removal of a sluice sink, is in hand. There was guidance for staff on appropriate washing machine programmes to clean laundry properly. There were accessible handwash facilities in the laundry and kitchen. When we looked at the kitchen, we were asked to wear a disposable apron for reasons of hygiene. We saw meal trays were covered whilst being taken to people. Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing arrangements are not sufficient to ensure people will receive all the care they need or want, in a timely way, from suitable staff, although some improvements are already underway. EVIDENCE: When we arrived unannounced on the first day, there was an agency nurse in charge (who had worked at the home before), a newly qualified nurse still employed in the capacity of a care assistant whilst waiting for their registration as a nurse to be completed, and four other care assistants, to care for 15 people. Staff told us this was a good level of staffing, and more than usual; they didn’t know why there were more staff rostered some days than others. They said there was always a nurse on duty, with three carers on in the morning, two carers the rest of the day (though occasionally there might be three in the evening) and one carer overnight. However, rotas from recent weeks showed 4-5 staff on duty during the day, apart from some weekends. There was also a cook, a kitchen assistant, a cleaner, a laundry assistant and a maintenance man on duty to support them for much of the day. Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 25 The ‘expert by experience’ found staff - some of whom had worked there for 25 or more years - were generally well liked, being described as kind and helpful. Professionals also reflected this. However, we noticed little personal interaction between staff and residents, apart from when answering a bell or giving physical care. Three people were not so pleased with a minority of the staff who they said could sometimes be “off-hand”, if not rude (for example, when putting people to bed and settling them down for the night). See also the section on ‘Complaints & protection’. There was also the comment that people were often kept waiting a long time before someone responded to their call bell, one person saying staff were sometimes rushed. One person said they usually waited ten minutes, the longest wait being 45 minutes, with response time worse in the afternoons. Their room was on the ground floor. Staff told us there was usually one care assistant based here, with two carers working upstairs. All four staff surveys and one professional suggested staffing could be better. One said, “We often work short-staffed so people don’t get the care they deserve or pay for.” One staff member said staffing should be improved in relation to the level of peoples’ needs. The AQAA said everyone at the home needed two staff to help them, but staff did not think it was so many as this – suggesting about a third, although some individuals’ needs varied daily. One person had someone -arranged through relatives - with them throughout the day, because the home could not continually provide staff to keep them safe. The person we spoke with said staff were very supportive, attending promptly if they rang the bell, and giving any personal care the person required. We asked for recruitment information for four staff employed to work at the home since the random inspection. All had previous care experience. One person’s file did not show a start date. One file had no references in it, whilst another had only one, from a job held four years’ previously. One reference request said the person was applying for a care assistant’s post, when they were actually applying for a senior nurse post. There was no evidence that two gaps in someone’s employment history had been explored. One person was said to have NVQ2 in care but there was no certificate evidence of this. There was no up-to-date record or evidence of checks made with the Nursing and Midwifery Council to verify staff were registered to practice as nurses, although the administrator told us that these were done. One person said they had been disappointed with their induction, which was very brief, although their practice was observed by a senior carer in that time; they did not recall any written record confirming their induction. Another said their induction lasted a week. Two of four staff surveys said they were satisfied with their induction, with two indicating more could have been included. Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 26 Two staff who had worked at the home for at least a year said they had not had any supervision or appraisal and only one staff meeting had been held recently. Staff told us training had improved recently, with the Nursing Director holding sessions on topics relevant to current residents’ needs, and a few of them taking a recognised care qualification. Nearly half have achieved the qualification already. Training records showed external training, attended by small numbers of staff at present, to do with nursing care, etc. Two staff had attended training on diabetes, and on challenging behaviour; five had attended wound care updates; seven had had training by the Speech and Language therapists. We saw a notice offering relevant recognised courses/qualifications to non-care staff. Two people said they had not had updates on topics relevant to the needs of people they looked after- such as preventing pressure sores or helping people who have sight impairments. One person living at the home, when asked, said staff did not seem to understand their eye condition, putting the person’s light on when the person was managing better with it off, for example. Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Current management arrangements, whilst improving, do not yet ensure the home is being run so as to protect and promote the welfare and best interest of people living or working at the home. EVIDENCE: The search or a suitable manager is ongoing. One person’s supporter said there was always a nurse available for them to talk to. Staff said senior staff made themselves available. All four staff surveys suggested communication between staff could be better, with evidence of this found during our visit (see earlier sections). Some requirements made at previous inspections are still unmet. Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 28 We were told that there are small group residents’ meetings, although these are not minuted. Someone new to the home said they were sent a survey soon after they moved in. Senior staff told us the home sends annual surveys to people living at the home, their relatives, professionals who visit the home, and staff. A Quality Assurance report summarising the latest findings was on the noticeboard in the entrance hall. We discussed that it did not give the reader much useful information – saying for example ‘Standard not met’ or that most people were positive about the matter, without saying what the standard or subject was. We were told that the home does not keep personal monies for anyone, although this may change in future, and does not act as appointee for anyone. Although there are no secure facilities in peoples’ accommodation, there is centralised safe storage available. Information about people living at the home (care records and other personal information needed for administrative purposes) was kept in a room used as a staff room. This could be easily accessed by anyone going into the room. Some policies had the name of the provider’s other home and it was not clear if they had been checked to ensure they were suitable for this care home. Some documentation had not been updated to show CSCI instead of a former regulatory body. Current food safety guidance and record-keeping systems were being used when we visited the kitchen, with new stainless steel units and appropriate flooring seen. Staff thought an Environmental Health Officer had inspected the kitchen relatively recently, but the report wasn’t available. There were cleaning schedules, monitoring records for ensuring food safety (fridge/freezer temperatures, for example), etc., but these had not been signed regularly, so it was not clear whether the duties or checks had been carried out. The kitchen looked clean and orderly, however. A kitchen assistant who has been employed for three years did not have a basic food hygiene certificate. Senior staff said the person had not attended planned training. Two staff said their recent manual handling training had not been very relevant to their particular role. Senior staff were aware of this and had taken action to improve training in future. The maintenance man said he had had appropriate manual handling training, and training on infection control in relation to his duties. We saw a notice indicating five staff (including nurses) were attending first aid training soon, the home intending to have a first aider on each shift. Care staff told us they had had recent training on infection control, relevant manual handling and fire safety. One person said they were booked to attend food hygiene. Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 29 Bedrails were not routinely safety-checked (but only if a problem was reported). We were told the programme for fitting radiator guards is ongoing, all bedroom radiators having been covered. A first floor bathroom window we found could be opened wide was secured to remove the risk of falling. There was no system for routinely checking window openings were restricted. A fixed bath hoist had just been serviced. Bathwater was not unduly hot. The maintenance man told us that the heating systems had been serviced recently but a certificate verifying this wasn’t available yet. There was no evidence of adequate monitoring for risks from Legionella, with water temperatures checked yearly, although a professional report was obtained three years’ ago which included risk management advice. The maintenance man said he carried out safety testing of portable electrical appliances, especially items brought in by new residents. Someone living at the home said their bedroom door shut automatically every night (being held open in the day by an appropriate device). A visitor confirmed they heard the fire alarm tested regularly, and that it triggered the door closure device on the bedroom door. The maintenance man has had training through the local fire authority, to enable him to give appropriate fire safety training to staff. We saw recommended in-house fire safety checks were recorded regularly. We discussed it would be prudent to check exit routes, including external doors and the area beyond them, to ensure they were still safely usable. External engineers had serviced the fire safety system in June and October 2007. Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 30 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 1 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 1 Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? YES 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 OP1 Regulation 4 Requirement The registered person must produce a written statement (“the statement of purpose”) consisting of — (a) A statement of the aims and objectives of the care home; (b) A statement as to the facilities & services which are to be provided by the registered person for service users; and (c) A statement as to the matters listed in Schedule 1. (2) The registered person shall supply a copy of the statement of purpose to the Commission, and make a copy of it available on request for inspection by every service user and any representative of a service user. So that people have clear information about what service is being offered. 2. OP1 5 The registered person must produce a written guide (“the service user’s guide”) which shall include— (a) A summary of the statement of purpose; DS0000059789.V315753.R01.S.doc Timescale for action 31/01/08 31/01/08 Linksway Version 5.2 Page 32 (b) A description of the standard services offered by the care home to service users; (ba) the terms and conditions (other than those relating to fees) in respect of the accommodation, including the provision of food, personal & nursing care; (bb) details of the total fee payable for services referred to in subparagraphs (b) and (ba), and the arrangements for payment of such a fee; (bc) the arrangements in place for charging & paying for any services extra to those mentioned in sub-paragraphs (b) and (ba); (bd) a statement of whether any of the matters mentioned in subparagraphs (b) to (bc) would be different in circumstances where a service user’s care was being funded, in whole or in part, by a person other than the service user; (c) A standard form of contract for the provision of services and facilities by the registered provider to service users; (d) The most recent inspection report; (e) A summary of the complaints procedure established under regulation 22; (f) The address and telephone number of the Commission. (2) The registered person shall supply a copy of the service user’s guide to the Commission and each service user. (4) In paragraph (1)(bb), “total fee payable” means the fee payable before account is taken of any nursing contribution, as defined in regulation 5A(6), which may be payable by a Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 33 Primary Care Trust in respect of a service user. So that service users have clear information about the service in relation to its terms and conditions, and their rights and responsibilities. 3. OP9 13(2) The registered person must make arrangements for the recording, handling and safe administration of medicines received into the care home. So that a) Two members of staff sign to confirm hand written information on medication records is correct, to ensure clear records of any changes to medication instructions b) There is a clear audit trail for unwanted medication and medication disposed of by the home; c) People are enabled to selfmedicate safely if they wish to. The timescale for meeting this requirement was 14/07/06. The requirement has been partly met. 4. OP12 16(2n) The home must consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation. So people have the opportunity to exercise their choice in relation to leisure and social activities and cultural interests. The timescale set for meeting Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 34 31/01/08 31/01/08 this requirement was 14/08/06. This requirement has not been met. 5. OP15 12 (1a) & (3) The registered person must ensure that the care home is conducted so as— (a) To promote and make proper provision for the health and welfare of service users; (3) The registered person shall, for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain and take into account their wishes and feelings. So that people are having meals at times of day appropriate to them, their health & wellbeing. 6. OP16 22 (1), (2), (6) & (7a) 31/01/08 (1) The registered person must establish a complaints procedure for considering complaints made to the registered person by a service user or person acting on the service user’s behalf, (2) That is appropriate to the needs of service users. (6) Where a written copy of the complaints procedure is to be supplied to a person whose vision is impaired, the registered person shall so far as it is practicable to do so supply, in addition to the written copy, a copy of the complaints procedure in a form which is suitable for that person. (7a) The copy of the complaints procedure to be supplied shall include the name, address and telephone number of the Commission; and (8) The registered person shall supply to the Commission at its DS0000059789.V315753.R01.S.doc Version 5.2 Page 35 31/01/08 Linksway request a statement containing a summary of the complaints made during the preceding twelve months and the action that was taken in response. So that there is a clear accessible complaints procedure that includes timescales, our contact details, & keeping of an up-to-date complaints record. The registered person shall not employ a person to work at the care home unless— (a) The person is fit to work at the care home; (b) Subject to paragraphs (6), (8) and (9), he has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2; (c) He is satisfied on reasonable grounds as to the authenticity of the references referred to in paragraph 5 of Schedule 2 in respect of that person. So that people are looked after only by suitable staff. The registered person must, having regard to the size of the care home, the Statement of Purpose, and the number and needs of service users— (ci) ensure that staff receive training appropriate to the work they are to perform, including structured induction training. So staff are competent to do their jobs. The timescale set for meeting this requirement was 30/07/07. This requirement has not been met. Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 36 7. OP29 19 (1) 31/12/07 8. OP30 18(1ci) 31/01/08 9. OP31 Under Care Standards Act 2000 11 (1) Any person who carries on or manages an establishment or agency of any description without being registered under this Part in respect of it (as an establishment or, as the case may be, agency of that description) shall be guilty of an offence. The registered person must submit an application for registration of a manager. The registered person shall— (1b) Ensure that the record referred to in sub-paragraph (a) is kept securely in the care home. (2) The registered person shall maintain in the care home the records specified in Schedule 4. (3) The registered person shall ensure that the records referred to in paragraphs (1) & (2)— (a) Are kept up to date; and (b) Are at all times available for inspection in the care home by any person authorized by the Commission to enter and inspect the care home. This includes safe storage of personal information about people living at the home, the Statement of Purpose, Service User Guide, complaints record, inventories of furniture, records of food provided, etc. 28/02/08 10. OP37 17 (1), (2) & (3) 31/01/08 11. OP38 13(4) The registered person shall ensure that — (a) All parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; (b) Any activities in which DS0000059789.V315753.R01.S.doc 31/01/08 Linksway Version 5.2 Page 37 service users participate are so far as reasonably practicable free from avoidable risks; and (c) Unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. So that risks of falling from windows, from bedrails, from Legionella, and from poor food hygiene are managed and minimized. 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 OP7 Good Practice Recommendations It is recommended you should ensure each person’s care plans sets out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the person are met. And updated to reflect changing needs and current objectives for health and personal care So it is clear what the person’s current care should be. 2. OP8 It is recommended you should promote and maintain peoples’ health, and ensure access to health care services to meet assessed needs, by developing care practices for people in pain, and ensuring good wound care practices are maintained. It is recommended you should ensure all people living at the home are given opportunities for stimulation through leisure and recreational activities in and outside the home which suit their needs. Particular consideration should be given to people with visual, hearing or dual sensory impairment or those with physical disabilities. It is recommended you should ensure people living at the DS0000059789.V315753.R01.S.doc Version 5.2 Page 38 3. OP12 4. Linksway OP14 home has lockable storage space in their bedroom, for medication, money and valuables So they are enabled to exercise choice & control in their lives. 5. OP27 It is recommended, having regard to the size of the care home, the statement of purpose and the number and needs of service users, you — (a) Ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users So there are enough staff on duty to care for people in a timely and safe way. 6. 7. OP28 OP30 It is recommended that you ensure staff are supported and encouraged to obtain NVQ 2 (or above) in Care. It is recommended, having regard to the size of the care home, the Statement of Purpose, and the number and needs of service users, you ensure that staff receive training appropriate to the work they are to perform So staff are competent to meet peoples’ individual needs. 8. OP33 It is recommended that the home continues to improve its systems for reviewing and improving the quality of care provided at the home, including the quality of nursing care provided - particularly with regard to minuted residents’ meetings, reports on quality surveys, etc. So people are more fully involved in the running of their home. Linksway DS0000059789.V315753.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. 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