Inspection on 14/01/09 for Linsell House

This inspection was carried out on 14th January 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Linsell House 03/09/07

Linsell House 28/12/06

Linsell House 09/01/06

Linsell House 24/06/05

Linsell House 02/11/04

Linsell House 21/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Linsell House Ridgeway Avenue Dunstable Bedfordshire LU5 4QT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Nicky Hone     Date: 2 1 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Linsell House Ridgeway Avenue Dunstable Bedfordshire LU5 4QT 01582699438 01582477844 linsell@bedscc.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Central Bedfordshire Council Name of registered manager (if applicable) Mrs Geraldine O`Neill Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: 1. The registered person may provide the following category/ies of service only: Care home only Code PC 1. The registered person may provide the following category/ies of service only: Care home only Code PC 2. The maximum number of service users who can be accommodated is: 16 LD - Learning Disability (Longstay) (12) LD - Learning Disablity (Respite) (4) Period of stay for respite service users - max 6 weeks Service Users may also have additional physical disabilities of the following age range: over 18 years to service users of the following gender: Either to service users of the following gender: Either whose primary care needs on admission to the home are within the following Care Homes for Adults (18-65 years) Page 4 of 32 care home 16 Over 65 0 16 categories: Learning Disability Code LD whose primary care needs on admission to the home are within the following categories: Learning Disability Code LD Date of last inspection Brief description of the care home Linsell House is owned and managed by Bedfordshire County Council and is located in a residential area of Dunstable. The home has 12 long stay places and 4 respite care places for adults with profound learning and physical disabilities. Community nursing support is accessed as required. The home comprises three single storey interlinked bungalows (Green, Peach and respite), each with their own sleeping, living, bathing, and kitchenette facilities. A large main kitchen, staff rooms/offices, laundry room, and a shared lounge are also provided. The organisation of the home and the building is institutional in a number of aspects. To this end, a long-term plan for the home is re provision, but there are no known timescales for this. Community facilities and shops are situated reasonably close to the home, which is also in easy access of local public transport routes. Transport is provided by the home. Parking is to the front of the property, and a fair sized garden surrounds the buildings. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: For this inspection we (the Commission for Social Care Inspection) looked at all the information that we have received, or asked for, since the last key inspection of Linsell House. This included: - The AQAA (Annual Quality Assurance Assessment) that the manager completed and sent to us in June 2008. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living at the home. It gives the manager the opportunity to say what the home is doing to meet the standards and regulations, and how the home can improve to make life even better for the people who live and stay here. The AQAA also gives us some numerical information about the service; Care Homes for Adults (18-65 years) Page 6 of 32 - Surveys which we sent to the home to give to people who live and stay here, their relatives/carers and to staff. We had no replies from the first batch of surveys we sent, so following the inspection we sent some more for the home to give to staff and relatives. We received 4 replies from relatives/carers on 31/01/09 and none from staff. - What the service has told us about things that have happened in the home. These are called notifications and are a legal requirement; - Any safeguarding issues that have arisen; and - Information we asked the home to send us following our visit. This inspection of Linsell House also included a visit to the home on 14/01/09. No-one who lives or works at the home knew we were going to visit on this day. We spent time talking to the manager, area manager and other staff. We looked round the home and spent time in one bungalow, observing what happens when people return home. We also looked at some of the paperwork the home has to keep including care plans, risk assessments, medication charts, and records such as staff personnel files, staff rotas, menus and fire alarm test records. We were assisted with this inspection by an Expert-by-experience (referred to in this report as the Expert). This is a person who, by having a shared experience of using services, helps us to get a picture of what it is like to live in the home. The Expert and his supporter spent two hours at Linsell House. Unfortunately there was only one person for the Expert to speak to as everyone else was out. This person was not able to communicate with the Expert, neither with words nor by using pictures, so the Expert asked questions of the persons keyworker. The Expert also looked round the home, spoke with staff and gave feedback to the manager. The Expert wrote a report following the inspection and some of his comments are included in this report. What the care home does well: What has improved since the last inspection? Following our last inspection we made 8 requirements. 5 of these had been met: people now agree a contract with the home; each person has a care/support plan; more permanent staff are being provided; staff have received training in safeguarding people from abuse; and the maintenance programme has been implemented. The manager said that the number and range of activities offered to people is improving, but still has a way to go. 1 of the requirements (that peoples nutritional needs must be assessed) was not checked this time. Care Homes for Adults (18-65 years) Page 8 of 32 In the AQAA the manager summarised some of the improvements she feels the home has made in the past year. These include staff recruitment; improving the environment; service user meetings; and staff supervision. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their needs have been fully assessed so that staff will know how to support them well. Evidence: Linsell House has a Service User Guide (SUG), and each person has a contract, which describes what the person can expect from the home. The contract now includes the fees people have to pay to live/stay at Linsell House, but does not make it clear if people will have to pay for extras, for example whether they will have to pay for holidays, outings and so on. Some of the information in the SUG was out of date: the named area manager had left, and the address and telephone number for the Commission (CSCI) had changed about 15 months before our visit. CSCI reports are available in the hallway for people to read, as are copies of the Statement of Purpose and SUG. There is a lot of useful information for people and their relatives in the hallway. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: The manager said that they aim to have full assessments in place for people before they are admitted, but very occasionally this does not happen. Some people have lived at the home for a long time: one of the people whose files we looked at has lived here for over 20 years. A full re-assessment of this persons needs took place in June 2007. Also, the care manager from the social services team carries out a review every year which is an assessment of the persons current needs, and a review of how well the home has met those needs. At the time of the inspection there was one permanent vacancy at Linsell House. One of the residents had decided to move out, so advocacy had been involved to make sure the person was supported with this decision. The manager explained that a second person has now decided they would like to move out, so will be supported with this. Anyone new who wants to come and live or stay at Linsell House will be supported through a transition period which meets their needs. For example they can visit the home several times, staying longer each time, then overnight, or a weekend, until they feel comfortable. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have been involved in putting together their support plans which are clear and detailed, and give staff good guidance on the way each person wants to be supported. Evidence: Each person has a detailed support plan in place, for their daily routines and personal care. The plans we looked at gave good information and guidelines for staff, and were written in a very person-centred way, using I to describe the care and support which the person wants/needs. In the AQAA the manager said that each person is involved in developing their own support plan with staff, especially their keyworker: the plans we saw showed that this had happened. We saw that different guidelines had been developed for the weekends, when the person does not have to get up to go to their day service. For example I like a lie-in, have a bubble-bath, wear comfortable clothes and so on. This plan had been reviewed in February 2008, so should have had a second review within 6 months. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: On one persons My Life file we saw that a traffic-light system has been used as part of the person centred planning work to record whether the person has, for example, been able to make choices, feel safe, feel that people are listening and so on. Each person has two keyworkers (to make sure one is always available). In the AQAA the manager said that people meet with their keyworkers monthly to discuss aspects of their care and support and to plan for the future. Each of the residents has a small folder of photographs which show how that person communicates, how they express their feelings, their likes and dislikes and gives brief, relevant personal information. People take these communication passports with them so that the same methods of communicating which are used by staff and by their family are used wherever they go, (day service, college and so on). The Expert said he thought this was a brilliant idea. Risk assessments had been carried out for all risks that each individual could encounter, such as being out in the community, using an electric bed, bed rails and manual handling. The assessments and guidelines for managing the risk, particularly for manual handling, were clear and detailed. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The opportunities offered to people for personal development and activities, so that they can lead full, satisfying and interesting lives, are improving. Evidence: The manager told us that a number of festivals are celebrated at Linsell House, not just Christian festivals such as Christmas and Easter. One of the people who has lived at the home for a long time is Hindu and particularly enjoyed the Divali celebrations. According to her support plan, this person likes to visit the temple: staff said she is supported to go to the temple when she chooses to, which is usually for special occasions. We looked at the activity records for three people. Each person has a weekly activities and tasks plan, broken down into morning, afternoon and evening. Each person Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: spends four days a week at a day service away from Linsell House, and then has one day off to do whatever they choose to do. There were only two people at home on the day we visited: one chose to go and do some shopping, then have lunch out. The second person went out for a walk in the local area, and then lunch out. Daily records written by staff gave a good, detailed picture of the way each person had spent their day, and showed that people do a lot of activity. The Expert spent time with one person. Unfortunately this person was unable to communicate with the Expert, either verbally or using visual aids, so the support worker answered the Experts questions on her behalf. She said the person makes her own choices about what she wants to do, and where she wants to go. She plans her day off in advance, and sometimes likes to go shopping for food. She has a bus pass or uses a taxi if the weather is bad. The person is able to show, vocally or visually, using facial and body movements, what she likes/does not like and what makes her happy. We saw that one person has a scrapbook of photographs showing her involved in a number of activities. It was clear from the pictures, and from the records, that this person is very busy, and really enjoys the things she does. Staff told us they are investigating whether people can attend more courses at college, rather than do college courses at the day service. A review carried out by Luton Borough Council in September 2008 had identified that more activities could be provided at weekends. The manager said this had improved, but there was still much room for further improvement. Staff in one of the two permanent bungalows told us that everyone was booked to go on a holiday of their choice in 2009. Families of the people who live and stay at Linsell House are encouraged to be involved in their relatives lives as much as they want to be. Several people spend weekends, or days with their relatives. If needed, staff support people to keep in contact with their families. The person who the Expert met spends each Sunday with her parents, and her keyworker supports her to take telephone calls. An advocacy service is available for anyone who needs support. Advocates were heavily involved with the person who moved on recently from Linsell House, and will be involved with the person who has shown an interest in moving to supported living. The Expert noted that each person has a post-tray with their photograph on it, so they know if they have any mail: the Expert thought this was a fantastic idea. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: Linsell House still has one main kitchen where most of the food is planned, ordered and cooked. The manager said the cook is very good at involving the people who live here in planning their meals, and at encouraging people to try new meals. Pictures of meals are used so that people can make choices about what they would like to eat. During the week, breakfast is whatever each person wants: a choice of cereals, porridge, toast, baked beans, scrambled eggs and so on. Lunch is provided by the day services and people who are at home during the day make their own arrangements for lunch (either out or making a snack lunch in their bungalow). The main meal is in the evening. On Saturdays, a big brunch is cooked and then a meal in the evening, and on Sundays a traditional roast is cooked at lunchtime. Snacks are available at any time and there is always a range of things available for people who dont want what is on the menu. Each bungalow can also choose to have a take-away of their choice. A chart is completed every Sunday showing what each person has chosen to eat for the week ahead. The manager told us the deputy manager is currently having discussions with the day services about their lunchtime meals, so that the homes menus can be planned to ensure people dont have the same meal twice in one day. Although the staff do their best to involve people in menu planning and so on, the manager agreed that having one main kitchen is a very old-fashioned way of providing meals. It would be so much better for people to help with doing the shopping, preparation and cooking of their meals, in each bungalow. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported with their personal care in the way they prefer, but there is not an adequate system in place to make sure that peoples healthcare needs are addressed in the best way to make sure they remain as healthy as possible. There have been a number of medication errors which shows that staff do not administer medicines correctly and safely enough to make sure people are kept safe. Evidence: The folders we looked at contained detailed support plans for all aspects of the care and support the person needs, for example, with personal care, dressing, using the toilet, gastrostomy and so on. It was clear from these that staff had spent a lot of time working out the ways in which each person prefers to be supported, and the detail of the guidelines makes sure that the person gets consistent staff support. A Health Action Plan (HAP) was in place for one person. This had been started in April 2008 but was not complete. For example we could not find any information about when the person has their teeth, sight and hearing checked. Following the inspection Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: the manager wrote to us, saying that there is an appointment sheet in all the files where appointments such as flu jabs are recorded. However, this still does not give adequate information about how often each person needs to have appointments with other health professionals, such as dentist, optician, chiropodist and so on. For the people in the respite unit, their main carers are responsible for making sure their health needs are met, although the home will arrange for medical treatment if it is needed during the persons stay. Staff should be trained so that they can assist people safely with their medication. A lot of errors in medication administration had happened at Linsell House since our last inspection. None of the people involved had been badly affected by the mistakes, but nevertheless mistakes are not acceptable. The manager was aware of this and said that each time, she had spoken to the staff concerned. She had also put it on the agenda for the staff meeting which had taken place the day before our visit, telling the staff that this level of mistakes was not acceptable. She planned for all staff to go on refresher training, and that the managers would observe staff giving medication, and would check it had all been given. We advised the manager that we thought these actions should have been implemented much more urgently. A few days after the inspection the manager sent us an email to say that all staff would be re-trained, and observed, within the following two weeks. The manager told us that new staff are booked onto a very thorough course which includes medication awareness, administration, and theory, as well as pharmacy. The staff member then has as many supervised sessions as necessary until they are deemed to be competent and confident to administer medicines on their own. Each person has a contract in the medication file which they, or their representative have signed to say they are happy for staff to administer their medicines. The file contains a medication profile, and details of how I like to take my medicines. We looked at the Medication Administration Record (MAR) charts in one bungalow. These were all signed satisfactorily, except that one alteration to the chart had not been signed. A letter in the file explained why this change had taken place and who had authorised it. We saw a bowel management plan in the medication folder which said administer enema. The manager explained that the district nurse would be called in to do this, but the plan did not make this clear. Stock cupboards for medication were old and damaged, so although they were padlocked, they could be broken into easily. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that their concerns will be listened to and acted on, and that staff are trained to keep them safe from harm. Evidence: Linsell House has a complaints procedure which is displayed so that people know who they can complain to. This is available in a pictorial format so is suitable for most people who live and stay here. However, some of the details were not up to date. A complaints log is kept: no complaints had been received since 2005. The manager said the staff team deal with concerns quickly so that they dont become formal complaints. In the AQAA the manager said that the home has an anti-bullying DVD which is shown to people so that they can start to understand and recognise what bullying is, and that it is unacceptable. She also said that Safeguarding (SOVA) policies were being read to individuals. A record is kept of any incidents that have to be reported to the Safeguarding (SOVA) team. The staff training record showed that all staff have had training in safeguarding within the last two years. Contact numbers for the SOVA team, and the procedure for staff to follow are clearly displayed in the office. None of the people who live at Linsell House are able to deal with their own financial Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: affairs without support. All except two people (whose parents hold their bank accounts) have their own building society account, and a small amount of cash is kept in the safe for them. A record is made of any money that goes in or out: we checked one persons records which were accurate. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Once the decorating has been finished, and the furnishings replaced, Linsell House will offer people a comfortable, attractive and clean place to live and stay in. Evidence: The Expert was shown round the home by a member of staff. He said the residents bedrooms were full of personal touches, with pictures on the walls and their own furnishings etc. He observed that the home looked clean and tidy. At the time of our inspection, Linsell House was being decorated and having most of the carpets, curtains and furniture replaced. Some of the decorating had been done, and there was a plan for the rest of the work to be completed. Each bungalow has its own lounge, dining area and kitchenette, a number of single bedrooms which each have a washbasin, and bathrooms and toilets. In the AQAA the manager explained that the kitchenettes has recently been completely altered so they were now more suitable for use by people with disabilities. One of the lounges has a separate area which is a snoozelen (or dark room), fitted out with soft things to lie on (mattresses and beanbags), sensory lighting and music. When we saw this room it was full of furniture. Some people who live at Linsell House Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: have a large, specially designed wheelchair, and a large comfortable chair. There is not enough space in the lounges for both. Staff told the Expert that the chairs are stored in the snoozelen during the day, when people tend to stay in their wheelchairs, but can be used in the evenings when people are using their comfy chairs. The lounge in the respite bungalow is much larger, and there are never more than 4 people, but it looked chaotic, with chairs dumped in the corner, facing the wall, and other items around which made it look very unwelcoming. We noted that generally there is not enough storage space at Linsell House. In spite of the decorating taking place, the home was clean throughout and smelt fresh everywhere. Staff clearly work hard to make sure peoples continence needs are met so that there are no unpleasant odours. We noted some minor defects, such as some damaged tiles and stained flooring in one bathroom, and a rather unsightly, broken medication fridge still on the wall in one kitchenette. The manager assured us that all these details will be taken care of once the refurbishment is complete. She said that the broken overhead hoist in one of the bedrooms is to be replaced. One relative who responded to our survey was not happy that this is the second time the hoist has been broken, and it takes a long time to fix. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are not always enough staff on duty to meet peoples needs, and staff have not received sufficient training to make sure they know the best way to support each person. Evidence: The manager said Were now the best off for staff since Ive been here with only 2 part-time vacancies for a domestic/escort and a cook left to fill. At least 6 new staff had started since September 2008, and 2 more were waiting for start dates. The number of staff on duty during the day depends on what the people who live at the home are doing. There are always 2 night staff awake during the night and a senior person sleeps in the building in case of emergencies. Up until very recently the home has relied heavily on agency staff. Some of the relatives who responded to our survey made some positive comments about the staff, especially the permanent staff (see summary of this report). However, three of the four relatives who responded also commented on the shortage of staff, that agency staff cant give the same support as they dont know people as well, and that peoples activities have been curtailed because there havent been enough staff for people to be supported to go out. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: We looked at the records the home keeps about two of the staff. There was a proforma in place, showing that all the necessary documentation is in place in their personnel files, which are held centrally at County Hall. These had been verified by a senior manager. We spent a morning in June 2008 checking a random selection of files of staff who work across the County Councils registered services. Generally all the required information was available on the files we looked at. Some staff have been employed for many years, and started long before the current requirements were in place. The Council has worked hard to get as much information as possible, and has ensured, for example, that Criminal Record Bureau (CRB) checks have been done, and are renewed every three years. The home has a detailed induction checklist which is worked through step by step with all new staff until it is complete and signed off: we looked at one of these on the file of one of the staff who started in September 2008 and saw that it had been completed and signed. Supervision is cascaded down, so the manager supervises the deputy and assistant managers, they supervise the team leaders, who supervise the rest of the staff team. Supervisions are done regularly and annual reviews take place for all staff. Staff training records that we saw in the home on the day of the inspection were not up to date enough for us to know which staff had done which training courses. The manager told us that records relating to any training arranged by the Bedfordshire County Councils Training and Development Department are held on a central database. Following the inspection the manager sent us this information in an email. She also said that records of any training arranged by the home, for example gastrostomy, diabetes, buccal midazolam, are not added to the database but kept at the home. Overall, we did not have sufficient information to be able to confirm that staff have received adequate training. In her email she stated that she and one of the assistant managers will be putting individual training plans in place for each staff member, which they will be responsible for keeping up to date and bringing to each supervision. Each staffs personal training needs can then be identified and training sought. The manager said that all staff, except the new people, have been awarded an NVQ in care level 2 or 3. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The number of requirements show that the management of the home needs to improve even further so that people are offered the best possible quality of life, and are kept safe. Evidence: Although this inspection has resulted in several requirements, the manager has shown, by what she wrote in the AQAA and in our discussions, that she is aware of some of the areas where the home can improve, and she has plans in place to achieve improvements. Staff we met and spoke with were very enthusiastic and seemed determined to offer the best possible service to the people they support. The manager showed us a copy of a newsletter which the home now produces so that everyone knows what is going on, and what is planned for the home. A copy is sent to relatives, and copies are available in the hall. The manager said this is a new venture: one was produced and posted to all families in September 2008, and the next one would be sent out before the end of January. Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: We discussed the homes system for making sure they offer a quality service which is what people want (Quality Assurance - QA). A survey had been devised and sent out and the results were evaluated by someone from another service, who then wrote an anonymous report. Meetings are held with the people who live at the home each week to decide what they want to eat the following week, and keyworkers meet with their individual people to plan activities, holidays and so on. Each bungalow holds a residents meeting every couple of months: we spoke to one of the managers who is developing a way of typing the minutes, using pictures. A representative of the County Council (the provider) visits the home every month, as required by the regulations, and writes a detailed report of the visit. In the AQAA the manager confirmed that all the required policies and procedures are in place. However, from the information she gave us, some of these have not been reviewed for many years (for example 1995, 1996). We checked the fire logs. There were several logs in place, which did not make it easy to check. However, between them we found that tests of the fire alarm system and emergency lighting has been done as required. Fire drills have taken place and most staff have had fire training. The Fire Safety Officer (FSO) visited Linsell House in May 2008. He judged that the fire detection system was not adequate. This has since been replaced, and a letter following the FSOs second visit in December 2008 confirms that his requirements were met. From the training records, not all staff have had enough training in the topics related to health and safety (that is fire safety, infection control, first aid, moving and handling and food hygiene). Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 20 13 (2) The home must make arrangements for the safe handling, recording, administration, safekeeping and disposal of medicines within the care home. 31/10/2007 2 33 18 (1) The home must have 30/11/2007 adequate staffing levels with appropriate skill mix and ensure their continuity. Previous timescales of 15/02/07 met in part. Care Homes for Adults (18-65 years) Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 Fully up to date information about the home must be available. So that people know what to expect from the home, and what the home expects of them. 31/03/2009 2 19 12 There must be a system in place to make sure peoples healthcare needs are met. So that peoples health is maintained. 31/03/2009 3 20 13 Medicines must be administered correctly. So that people receive the medicines they need in a safe way. 02/03/2009 4 24 23 The decorating and refurbishment must be completed, and any defects noted on the day of the inspection must be rectified. 31/05/2009 Care Homes for Adults (18-65 years) Page 29 of 32 So that people have a comfortable, wellmaintained place to live in. 5 29 23 All equipment must be maintained in full working order. The broken hoist must be repaired or replaced. So that people have the equipment they need to maintain their independence and to ensure they are supported safely. 6 33 18 There must always be enough staff on duty. So that peoples needs are met, and people have a good quality of life. 7 35 18 Records must be available to 31/05/2009 show that all staff have received sufficient training. So that they can do their job in the best way possible. 8 42 18 All staff must receive 31/05/2009 training in the topics related to health and safety (that is, fire safety, moving and handling, first aid, food hygiene and infection control). So that staff know how to keep people safe. 02/03/2009 15/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. Care Homes for Adults (18-65 years) Page 30 of 32 No. Refer to Standard Good Practice Recommendations 1 14 Arrangements should be made so that people are able to participate in activities of their choice, especially at weekends. The provider should consider changing the way meals are provided so that people are able to be part of the shopping for, preparing and cooking of meals. The complaints procedure should always be up to date, with accurate details, so that people can contact others if they want to complain. The provider should consider providing additional storage space. The homes policies and procedures should be regularly reviewed and updated when necessary. We recommend that only one log is used to record all the tests of the fire detection systems. 2 17 3 22 4 5 6 24 40 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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