Inspection on 24/06/05 for Linsell House

This inspection was carried out on 24th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Linsell House 14/01/09

Linsell House 03/09/07

Linsell House 28/12/06

Linsell House 09/01/06

Linsell House 02/11/04

Linsell House 21/06/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Linsell House Ridgeway Avenue Dunstable Beds LU5 4QT Lead Inspector Rachel Geary Unannounced 24 June 2005 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Linsell House Address Ridgeway Avenue Dunstable Beds LU5 4QT 01582 699438 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Bedford Borough Council Care Home 16 Category(ies) of LD - Learning Disability registration, with number of places Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Period of stay for respite service users - max 6 weeks. Service users may also have additional physical disabilities. Date of last inspection 2nd November 2004. Brief Description of the Service: Linsell House is a local authority care home based in a residential area of Dunstable, providing long stay (12 beds) and respite care (4 beds) for up to 16 adults with profound learning and physical disabilities. Community nursing support is accessed as required. The accommodation comprises of three single storey interlinked bungalows (‘Green’, ‘Peach’ and respite), each with their own sleeping, living, bathing and kitchenette facilities. An industrial kitchen, staff rooms/offices, laundry room and a communal living area are also provided. The organisation of the home and the building is institutional in a number of aspects. To this end, a longterm 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 although at the time of writing, there was a shortage of drivers within the current staff team. Parking is to the front of the property, and a fair sized garden surrounds the buildings. Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The previous announced inspection of Linsell House had mainly concentrated on support systems and the management of the home. To this end, this inspection focused on assessing outcomes for service users. A number of requirements and recommendations from the November inspection report have therefore not been looked at in full on this occasion. These will be assessed at the next inspection of this service. This inspection was unannounced and lasted for eight hours. The inspector spent the majority of the inspection within ‘green’ and ‘respite’ bungalows observing practice and speaking to service users, staff, and relatives of one service user. Records were also looked at, and a partial tour of the premises took place. What the service does well: What has improved since the last inspection? This was discussed on a number of occasions during this inspection. There was a general feeling that not a lot had improved in respect of outcomes for service users. Some things that people did come up with was that staff, other than one person’s key worker, had arranged for a service user to go out to buy things for his holiday. In addition, some new carpets and DVD players had been provided. Some previous inspection requirements had also been addressed. Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1. The home’s Statement of Purpose and Service User Guide provide some useful information for prospective service users and their representatives, enabling an informed decision about admission to the home. EVIDENCE: The Service User Guide and Statement of Purpose had been updated since the last inspection of this home. The Service User Guide had been illustrated with pictures to make it more accessible to service users. It contained the majority of the required information. Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 10. Care plans and current practices do not adequately promote individual choice, or opportunities for service users to develop skills. EVIDENCE: There was little evidence of any changes having been made in this area since the last inspection of this home. See also other relevant sections of this report. Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 10 Care plans contained some useful information but were still limited in the objectives being set and how these were to be achieved. Plans were not yet user friendly. Plans highlighted information particularly relating to the health needs of service users. There was no evidence of service user/representative input, individual’s own aspirations, and goals to maximise independent living skills and opportunities. There were a number of folders for each service user in various locations, which would need to be read together to get a complete picture for that person. It was discussed that this could be quite confusing. There was evidence that some information had not been reviewed for some time, and some was undated/signed. Photos of service users were also not consistently held on file. During this inspection a risk assessment was carried out regarding transport for a service user holiday due to take place in 3 days time. The assessment highlighted a need for additional transport and staff. It was unclear why this had been left until the last minute, and concerns were raised with regard to the practicalities of making these arrangements with such little notice. Some information relating to service users was being stored within the living areas of the bungalows. Locks had been fitted to promote security and confidentiality however; these were not in use on this occasion. Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 13, 14, 16 and 17. Choice and participation for service users with regard to personal development, leisure activities and meal preparation and planning is poor. EVIDENCE: On arrival, two service users were supported by staff to go shopping as part of preparations for their holiday the following week. Another service user was supported to attend a health care appointment, and one lady was picked up by her parents for an overnight stay. In addition, plans were in hand for a BBQ the day after the inspection to celebrate the birthday of one service user. Despite this, there was still evidence of poor regular opportunities for external activities for all service users, particularly at weekends. A number of reasons were provided for this which included a lack of permanent staff, a lack of staff who were trained to administer medication, a lack of drivers (particularly significant for service users whose specialist equipment makes public transport difficult), no available petty cash, and limited available service user finances. Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 12 Some staff indicated that they would be happy to undertake the training to drive the home’s vehicles. Furthermore, two service users had previously expressed an interest in moving on from the service. Plans had been made for one of them to visit a local supported living project however; this had then been cancelled due to a lack of available medication trained staff. Meals were being prepared in a central industrial kitchen. Service users did not therefore participate in meal planning or preparation, and external suppliers were delivering food in bulk. One service user was observed having a lunch of pizza and garlic bread. Unfortunately, this needed to be rushed due to a healthcare appointment. The evening meal on the day of this inspection was turkey burgers and new potatoes with bread and butter pudding and custard. There was no choice however, vegetarians were offered an alternative, and the cook had made one salad as an additional request. Some service users did not appear to want the meal offered to them and when questioned, staff explained that alternatives such as crisps or a sandwich could be offered. This did not happen however on this occasion. The inspector queried if likes and dislikes were noted for future meal planning, and was told that individuals’ preferences may change from day to day. It was also explained that recording a person’s dislikes was likely to be missed due to the high ratio of different staff working with individuals. On a positive note, a daycentre communication book recorded that the service user in question had eaten well earlier in the day. Meal trolleys were brought to the bungalows at 4pm, although service users ate between 5.30 and 6.30pm. Support was provided to service users with regard to feeding. Due to the ratio of staff to service users, two separate sittings for dinner were required. There was little evidence that staff encouraged service users to feed themselves. One service user could not eat due to medical needs. It was noted that because staff were busy supporting other service users, that there was little inclusion for this person for the duration of the meal. Due to a lack of specialist eating equipment being stored within bungalow kitchenettes, it was noted that staff sometimes needed to leave units to obtain equipment. Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 and 21. Current staffing arrangements and practices do not adequately promote the individual needs and preferences of service users with regard to personal and health care, or flexibility of service provision. EVIDENCE: Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 14 There was evidence to suggest a number of institutional practices were in place. One example was bedtimes where it was described that due to staffing issues, rotas, policies and procedures, and the need to share bathing facilities, some service users would be supported to start getting ready for bed from as early as 6.30pm. In addition, staff did not always address service users directly when talking about them, or used terminology that was not appropriate for supporting adults. One service user was observed trying to walk around her living area. Staff encouraged her to sit down and explained that this was due to her tendency to place dangerous objects in her mouth. This could be seen as a restriction, and should be reviewed. Another service user was heard to be screaming whilst having her hair dried by a member of staff. Staff explained that the lady in question often became upset when being supported with personal care. It was noted however that she stopped screaming when the hairdryer was switched off and the inspector queried why she needed to have her hair blow dried at all. A member of staff said that they did not want her to go to bed with wet hair despite this happening at only approx 8pm. Staff explained that within the respite unit, daily notes relating to all aspects of service users’ care are photocopied and sent home with them for parents/carers to read. The inspector understands the need to pass on need to know information, but queries how appropriate it is when supporting adults, to share all information without the consent of the individual service users. Staff indicated that they would feel uncomfortable to record some things because of the current system. Discussions had previously taken place regarding the home’s intercom system, which is used to monitor service users at night time. Previous inspections had requested that the home consider alternatives that promote service users’ privacy, dignity and human rights. It was noted that the home had introduced some decision making/consent forms for issues such as this. Due to the profound disabilities of service users, part of this process involved getting a thumbprint as agreement from each individual. The inspector was concerned about this arrangement and stressed that this could only be used to demonstrate that information had been shared with individuals rather than this being an indicator of consent. Representatives of service users were also requested to give their consent however, it was discussed that at times this would also be inappropriate, and that important decisions should be made as part of a multi agency approach. Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 15 One service user was supported to attend a healthcare appointment during this inspection. A taxi had been booked because of difficulties in accessing public transport due to the person’s wheelchair. On arrival, the service user in question was not ready and the taxi driver was permitted to enter the home (by external service staff), and come as far as the staff room, where the service user was eating his dinner. Of some concern was the fact that the service user had to pay the £30 taxi fare from his own monies, yet there was no available contractual information, which set out this type of arrangement. Service users’ health care needs were being addressed within care plans and related documentation. Information was provided however which indicated that one service user had consistently missed an important healthcare appointment due to a failure regarding in-house systems and planning. The home’s policy with regard to medication requires that two trained staff administer all medication as required by service users. It was observed that due to a lack of available trained staff, staff were required to double up and provide support to other bungalows. This resulted in periods of time when staffing levels and supervision were reduced in some of the living areas. In addition 2 members of staff were required to stay on past the end of their shift for the same reason. This had not previously been agreed with at least one of them. Guidelines for shift planning indicated that where possible, there should be two trained staff on duty in each bungalow. There were a number of guidelines in place for individual service users which for various reasons required an assigned support member of staff per shift. Because of the above and the high usage of agency staff, this was proving to be difficult to manage. It was noted in one bungalow that there were periods of time when no staff members were present. This is of particular concern when one of the service users has a tendency to place inappropriate objects into her mouth. Another example was where staff needed to double up to provide personal care to one person, leaving other service users unattended. This was managed by leaving a bathroom door slightly open to enable staff to monitor other service users’ needs. It seemed very clear that these arrangements were impacting on the service’s ability to provide safe, individual, flexible and holistic support for the individuals living in the home. There was evidence that arrangements regarding terminal illness and death had been discussed with service users’ next of kin. Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 16 Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23. Further work is required to the current complaints procedure to ensure it is accessible and available to service users and their families/representatives. Arrangements for protecting service users were in place but are not always clear. EVIDENCE: A separate complaints procedure had been developed. Attempts to make this document user-friendly had been made, but could be further improved. Appropriate systems and protocols were in place for reporting incidents relating to the protection of vulnerable adults. It was not possible however to determine systems for monitoring and recording due to there not being a manager on duty during this inspection. An example of this was the home’s accident book. There was evidence that the manager acknowledged individual entries however, she was on annual leave and there were a number of entries going back as far as 14/6/05 which did not appear to have been acknowledged in her absence. Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 27, 28, and 29. The standard of the environment does not adequately meet required standards, although efforts have been made to promote a safe and comfortable place to stay. EVIDENCE: The organisation of the home and the building was institutional in a number of aspects. The management had previously explained that the long-term plan for the home was re provision, but no known timescales had been set. On arrival, the environment was noted to be clean, tidy and free from offensive odours. Three sample shades of green paint had been applied to the lounge wall in ‘green’ bungalow, and it was explained that this had been done to promote choice of colour for service users when redecoration took place. A mobile hoist was available in each of the bungalows. Staff described significant problems with using these including inadequacies in meeting service Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 19 users’ individual needs (i.e. height). In addition, it was observed that the controls on one hoist only worked intermittently or were broken. Décor, fabrics and furnishings throughout the home differed in quality. A number of carpets had been replaced although there was still damaged paint and plasterwork in communal corridors, and once again it was noted that the sofa in the respite bungalow was in need of refurbishment/replacement. A recent entry in a parents and carers communication book was noted; requesting donations for soft furnishings, pictures, and a TV stand for the home. There were a number of toilets and bathing facilities throughout the home, with separate facilities for staff. Some basic improvements had been made to these facilities, which had previously been reported on, as institutional in appearance. Once again the issue of the low water pressure from the respite unit shower was raised. It was discussed that this could result in service users feeling cold when taking a shower. It had also previously been noted that there was not enough room in Peach bungalow bathroom for a changing trolley and specialist equipment. To this end, service users were supported to undress in their bedrooms, covered up, and then wheeled through the communal area of the bungalow to the bathroom. This arrangement was still in place. During this inspection, it was discussed that on the return journey, service users had to sit on a wet hoist. Solutions to this unsatisfactory practice were also discussed including the provision of specialist equipment such as a ‘platform’ bath and/or an overhead hoist. Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 34. The provision of appropriately trained staff on each shift is inadequate to promote individual, consistent and flexible support to service users. EVIDENCE: Concerns regarding the staffing arrangements for this home have been reported on throughout this report. Staff indicated that staffing shortages and related arrangements were making it difficult to consistently provide support as set out in service users’ care plans. Staff were assigned to one of the 3 bungalows on commencement of their shift. As reported above, staff were required to move between bungalows during the shift. It did not appear to be normal practice for them to knock before entering another bungalow. Furthermore very few staff explained the presence of the inspector to service users and relatives, or attempted to make any introductions. This was left to the inspector despite the profound disabilities of some individuals. Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 21 Rotas indicated that there were a minimum of 8 support staff were on duty each morning and evening shift (3 in ‘Green’ and ‘Peach’, and 2 in the respite bungalow), and there were 2 waking night and 1 sleeping in members of staff each night for the whole building. One member of agency staff had not turned up for the morning shift and there was some confusion about the fact that this had reportedly been cancelled. Staff were being recruited according to County Council policies and procedures. Staff vetting documents were being held centrally and not within the home as required however, a BCC HR advisor had arranged for a sample of BCC staff files to be examined during another BCC service inspection on 31/5/05. There was evidence that since the last CSCI examination of staff files (10/11/04), that a number of improvements had taken place, and there were clear systems in place to ensure that (BCC care home) staff were being recruited in accordance with the Care Home Regulations 2001 (and amendments 2004). Agency staff were providing a significant ratio of care support. Staffing profiles, provided by the agency, had been developed for these workers. Similarly, a number of improvements had also been made to these profiles since the last CSCI inspection however; a random selection had showed that these did not yet fully meet the requirements of the regulations for care homes. This was being addressed at the time of writing. Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39 and 43. This service has experienced a considerable amount of change and instability, which continues to affect staff morale and opportunities for service users. EVIDENCE: Since the last inspection, the home had had another change in management, and Gerry O’Neill, had been appointed as manager from 1/4/05. Mrs O’Neill had submitted an application for registered home manager to the CSCI, and this was being processed at the time of writing. Negative vibes and low morale were detected within the staff team. A number of staff described what appeared to be a ‘them and us’ style of management, and some staff felt that managers did not regularly visit service users’ living areas, tending to shut themselves off within the office. As there were no Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 23 managers on duty on the day of this inspection, it was not possible to verify this adequately on this occasion. One report as required by regulation 26 of the Care Homes Regulations 2001, had been received by the CSCI since the last inspection of this service. The report was detailed and demonstrated an open and objective approach with regard to overseeing the management of this service. There were problems with the provision of hot water during this inspection, but this was attended to appropriately. Evidence of appropriate insurance to cover the organisations’ assets and liabilities, was in place. The resource manager had produced a business and financial plan specific to Linsell House for 2004/5. Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 x x x x Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x x 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x x 1 2 2 x Standard No 11 12 13 14 15 16 17 1 x 1 2 x 1 1 Standard No 31 32 33 34 35 36 Score x x 1 2 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Linsell House Score 1 2 2 2 Standard No 37 38 39 40 41 42 43 Score 3 1 2 x x x 3 I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 25 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 23 Requirement The registered person must provide evidence from the local Fire Authority (letter dated 1.12.04) for agreement to the practice of propping internal doors open. Not inspected on this occasion. Please forward copy to CSCI. The registered person must ensure the health, safety and welfare of service users and staff through the secure storage of disposable gloves and COSHH products in accordance with the home’s risk assessment procedure. This must also include the easy access to store cupboards and the laundry room (hot water). Not inspected on this occasion. The registered person must ensure that all information and individual records with regard to service users are kept secure and confidential. Timescale of 6.8.04 not met. The registered person must propose how service users are to I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Timescale for action Revised timescale 31.7.05 2. YA42 23 Revised timescale 24.6.05 and ongoing 3. YA10 17 Revised timescale 31.7.05 4. YA17 16 Revised timescale Page 26 Linsell House Version 1.30 be actively supported to help plan, prepare and serve meals in the home. 5. YA6 15 Timescale of 31.8.04 not met The registered person must ensure that care plans are developed to include clear goals with regard to individual service users’ own aspirations, and to maximise independent living skills as far as possible. In addition, plans should be produced with the involvement of the service user (and or family/representative/advocate as appropriate), and be in a language and format the service user can understand. Timescale of 31.10.04 not met The registered person must ensure that a quality assurance and monitoring system is in place for the home, which meets the requirements as set out in standard 39 of the National Minimum Standards for Younger Adults. Not inspected on this occasion. The registered person must ensure the health, safety and welfare of service users and staff by: ensuring that food fridges are maintained at the appropriate safe levels of 1-4ºc, and ensuring that food is fresh, covered, and date labelled. Not inspected on this occasion. The registered person must consider other options and apply some flexibility to the current systems, to ensure that all service users are given regular opportunities to access the community, and experience a I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc 31.8.05 Revised timescale 30.9.05 6. YA39 35 Revised timescale 30.9.05 7. YA42 13 Revised timescale 24.6.05 and ongoing 8. YA11 12 Revised timescale 31.8.05 Linsell House Version 1.30 Page 27 variety of recreational activities. 9. YA6 17 Timescale of 15.12.04 not met. The registered person must ensure that information maintained in respect of all service users is:· up to date (inc review reports), and that contingency measures must be in place to ensure that service users receive a consistent level of support in the absence of named key workers. 10. YA6 17 Timescale of 15.12.04 not met. The required records as set out in Schedule 3 of the care home regulations must be held in respect of each service user. This includes a photograph of each service user. Staffing arrangements must promote improved opportunities for service users to maintain and develop ordinary social, emotional, communication and day to day living skills. Service users must be offered a choice of nutritious menus which respect their individual preferences. The daily routines of the home must promote service users privacy, dignity, independence, individual choice and freedom of movement, subject only to restrictions agreed within individuals care plans and contracts. Procedures must be in place to ensure that service users routine health care checks are recognised and addressed. Staffing arrangements must be reviewed to ensure that adequate numbers of staff trained to administer medication 31.8.05 Revised timescale of 31.8.05 11. YA11 and 33 12, 16 and 18 31.8.05 12. YA17 12 31.8.05 13. YA 16 and 18 12 31.7.05 14. YA19 13 31.7.05 15. YA20 13 31.8.05 Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 28 16. YA23 13 are on duty as required by service users assessed needs, and to promote flexibility of service provision. Service users financial contributions towards transport for medical appointments and leisure activities should be agreed and made clear within individual contracts. In addition, systems must be improved to ensure that accidents and incidents are openly monitored and acted upon (as required) in the absence of the manager. Specialist equipment and shower facilities must meet individual assessed needs, and promote the comfort of all service users. Please review the provision of the bathing facilities in Peach bungalow, the manual hoists and the low water pressure in respite bungalow, and outline how and when identified deficits will be addressed. 31.8.05 31.7.05 17. YA27 and 29 12, 13 and 23 31.8.05 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 YA21 Good Practice Recommendations Consideration should be given to obtaining service users own wishes concerning terminal care and death. Where this is not possible, arrangements that are made should take into account the individuality of each person, and if necessaary be made as part of a multi agency approach. Consideration should be given to making the current complaints procedure more accessible to service users and their relatives/representatives. Consideration should be given to maintaining all current I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 29 2. 3. YA22 YA6 Linsell House 4. YA 18 and 41 information regarding individual service users within just one file per person. Consideration should be given to reviewing the current arrangement of directly photocopying respite service users notes to give to their parents/representatives. This should balance the need to pass on important need to know information, against individuals rights regarding consent and dignity. Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 30 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Linsell House I51 S32470 LINSELL HOUSE V222864 240605 stage 4.doc Version 1.30 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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