Inspection on 28/12/06 for Linsell House

This inspection was carried out on 28th December 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 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 09/01/06

Linsell House 24/06/05

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 Bedfordshire LU5 4QT Lead Inspector Mr Pursotamraj Hirekar Unannounced Inspection 28th December 2006 12:45 Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 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 Linsell House DS0000032470.V294857.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 Adults 18-65. 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. Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Linsell House Address Ridgeway Avenue Dunstable Bedfordshire LU5 4QT 01582 699438 01582 477844 linsell@bedscc.gov.uk 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) Bedfordshire County Council Mrs Geraldine O’Neill Care Home 16 Category(ies) of Learning disability (16) registration, with number of places Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. Care Home LD - Learning Disability (Longstay) (12) LD - Learning Disability (Respite) (4) Period of stay for respite service users - max 6 weeks Gender: Male and Female Age: Over 18 years Service Users may also have additional physical disabilities Date of last inspection 9th January 2006 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 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 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 DS0000032470.V294857.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of the unannounced inspection carried out on 28/12/06 over 6 ½ hours by Pursotamraj Hirekar. The manager coordinated the inspection through out. The method of inspection included study of care plans, risk assessments, personnel records, staff deployment duty rota, relevant care delivery documents, discussions with manager and staff, conversation with service users’ and partial tour of the building. This inspection report also includes information from the service users’ survey carried out by the commission and pre-inspection information provided by the home. What the service does well: What has improved since the last inspection? Attempts have been made to comply with the outstanding requirements and some success was achieved. The home had put out an advert for residential workers – 10 permanent posts, both bench mark and trainee post, 15 applicants have been short-listed for interviews to take place on 17, 18 and 22 January 2007. The home had made appropriate arrangements with external professionals for the delivery and care of the personal and health care needs of the service users’. The home had taken appropriate measures on the reported incidents to protect from abuse and neglect and harm of service users’. The home had refurbished respite bathroom and peach bathroom including the showers. The green bungalow was redecorated and new alarm call system was updated. The home had completed refurbishment of the bathroom with a new bath, shower, and changing table. This was achieved in March 2006. The respite unit also had bathroom refurbished with new shower, changing facility, this was achieved in May 2006. Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 6 Currently, the home was planning to refurbish the bathroom in the long stay unit – green bungalow and this likely to happen in financial year 2007 - 2008. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 7 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. Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had made appropriate arrangements for the needs assessment of the service users’ and the service users’ were aware of the care and services they would receive from the home prior to their admission. However, the home need to complete all sections of the care plan, enable service users and key stake holders’ participate in the development of the plan. EVIDENCE: The home had designed a comprehensive care-planning tool, which was used to write care plans of the service users’. The care plans included information about service users’ pen picture, people important to me, important things about me, how I communicate with you, how to communicate with me, if I don’t understand I will let you know by, medication, epilepsy, dietary needs, allergies, protocols, professionals, routine in the morning, when I get home, evening, day time, things I like doing, making me safe, what I can do for myself, choices that I make aims and goals. All service users’ have 24-hour care plan and support plan. In conjunction with another service the home was planning to launch person centred planning sometime in March 2007. Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 10 However, the care plan of a service user which was case tracked on this inspection was not complete in the areas of pen picture, people important to me, important things about me, my personal care in the morning, evening and during night, leisure things I like, things I do not like, things that make me happy, risk assessments making me safe, independence skills, there was no date when this care plan was written, no signature of the personnel who were responsible for writing this care plan and there was no evidence who all have contributed to the development of the care plan. The commission had carried out a service users’ survey prior to this inspection, to get the feedback from the service users’ and their family members about the services they receive at the home. In response to the question, which kind of home would be most suitable for them. 3 service users’ have responded to the service users’ survey undertaken by the commission, of which 1 service user had pre-admission visits, met staff and other service users’ living at the home. However, service user –2 said ‘we were unaware of any alternative at the time, Linsell house seemed to be the only option. The service is used for respite only, not residential’. Service user – 3 said ‘I liked Meldrith. I was asked but didn’t look around before. Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home must have appropriate arrangements for reviewing the care plans and reflecting the changing needs of individual service users’ care plans regularly. The home must enable service users and key stakeholders’ participate in the decisionmaking, review, and development of the care plan. EVIDENCE: The home was way behind in carrying out care plan reviews and regularly updating the same. Of the 12 service users’, the home had carried out reviews of 4 service users’ in 2006, 3 service users’ in 2005, and 5 service users’ in 2004. At this rate the reviews were not regular which poorly impacts upon updating care plans and ensuring appropriate care delivery in the best interest of the service users’. Service user – 1 care and support plan was seen on this inspection, which was comprehensive and was prepared in a user-friendly format. The front sheet of Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 12 the plan said ‘this care plan has been developed in addition to the basic 24 hour care plan. It has been put together with full involvement of service user’s parents, friends and key worker and other significant people involved in service user’s life’. However, there was no evidence with regard to date of original completion, date to be reviewed, date of previous review and no signature of friend, advocate, and service user and family member except key worker. The 24 hour care plan prepared was also comprehensive which detailed aspects of care delivery such as; domestic skills, programmes, cultural beliefs, leisure, garden and out doors, behaviour, diet, bath/showering, skin care, toileting, morning routine, night time needs, sensory room, sensory needs, mobility, aids and adaptations used, communication, healthcare needs, epilepsy, physical needs, positioning, risk factors, allergies, medication and bowel management. Only the key worker signed the detailed care plan and this document had under date reviewed 2 dates 3/1/06 and 14/8/06. There was no evidence to suggest that the service user and key stakeholders have participated in the preparation and review of the care plan. Also, there was no evidence to suggest what changes have been incorporated if the care plan was reviewed on 2 different dates. Service user – 2 care and support plan was seen on this inspection, which was comprehensive and was prepared in a user-friendly format. The front sheet of the plan said ‘this care plan has been developed in addition to the basic 24 hour care plan. It has been put together with full involvement of service user’s parents, friends and key worker and other significant people involved in service user’s life’. However, there was no evidence with regard to date of original completion, date to be reviewed, date of previous review and no signature of friend, advocate, and service user and family member except key worker. The 24 hour care plan prepared was also comprehensive which detailed aspects of care delivery such as; domestic skills, programmes, cultural beliefs, leisure, garden and out doors, behaviour, diet, bath/showering, skin care, toileting, morning routine, night time needs, sensory room, sensory needs, mobility, aids and adaptations used, communication, healthcare needs, epilepsy, physical needs, positioning, risk factors, allergies, medication and bowel management. The key worker and the team leader signed the detailed care plan and this document had under date reviewed 3 dates 12/8/05, 3/1/06, and 14/8/06. There was no evidence to suggest that the service user and key stakeholders have participated in the preparation and review of the care plan. Also, there was no evidence to suggest what changes have been incorporated if the care plan was reviewed on 3 different dates. Service user – 3 care and support plan was seen on this inspection, which was comprehensive and was prepared in a user-friendly format. The front sheet of the plan said ‘this care plan has been developed in addition to the basic 24 hour care plan. It has been put together with full involvement of service user’s parents, friends and key worker and other significant people involved in service user’s life’. However, the date of original completion recorded 12/04/05, date to be reviewed 24/11/05, and date of previous review 27/10/03 and no Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 13 signature of friend, advocate, and service user and family member except line manager dated 20/10/05. The 24 hour care plan prepared was also comprehensive which detailed aspects of care delivery such as; domestic skills, programmes, cultural beliefs, leisure, garden and out doors, behaviour, diet, bath/showering, skin care, toileting, morning routine, night time needs, sensory room, sensory needs, mobility, aids and adaptations used, communication, healthcare needs, epilepsy, physical needs, positioning, risk factors, allergies, medication and bowel management. The key worker (acting team leader) and line manager signed with date reviewed as 03/04/06. There was no evidence to suggest that the service user and key stakeholders have participated in the preparation and review of the care plan. Also, there was no evidence to suggest what changes have been incorporated if the care plan was reviewed. Service user – 4 care and support plan was seen on this inspection, which was comprehensive and was prepared in a user-friendly format. The front sheet of the plan said ‘this care plan has been developed in addition to the basic 24 hour care plan. It has been put together with full involvement of service user’s parents, friends and key worker and other significant people involved in service user’s life’. However, there was no evidence with regard to date of original completion, date to be reviewed, date of previous review and no signature of friend, advocate, and service user and family member except key worker. The 24 hour care plan prepared was also comprehensive which detailed aspects of care delivery such as; domestic skills, programmes, cultural beliefs, leisure, garden and out doors, behaviour, diet, bath/showering, skin care, toileting, morning routine, night time needs, sensory room, sensory needs, mobility, aids and adaptations used, communication, healthcare needs, epilepsy, physical needs, positioning, risk factors, allergies, medication and bowel management. The key worker, team leader and the manager have signed the detailed care plan under date reviewed 19/06/03, 10/12/03, 29/04/04 and 04/11/04 and further the care plan read updated 01/06/05. There was no evidence to suggest that the service user and key stakeholders have participated in the preparation and review of the care plan. Also, there was no evidence to suggest what changes have been incorporated if the care plan was reviewed on 4 different dates. All the 3 service users’ who replied to the commission’s survey have said that they do not make decisions about what they do each day, except for 1 service user who said sometimes. The above response from the service users’ indicate that the home need to look at ways of encouraging participation of service users in decision making process that would help them achieve quality of life goals. Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users’ dietary needs were assessed and choice of menu and timings were maintained, in the interest of the service users’. However, social activities carried out by the home needed revisiting and improvements made to suit the needs of the service users’. EVIDENCE: The home had developed two-pronged activity list one that provides recreational and educational activities within the premises, which were around 14 of them, and activities those can be accessed in the wider community which were around 33 different types. There were few incidents of activities being not achieved as planned were recorded in the activity chart; the reason was poor staffing levels. The home needs to look at the staffing levels and their deployment. Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 15 Mother of a service user - 1(respite) had said that the service user is unable to make decisions for him and the communication between the service user’s family and the home is poor. The mother of a service user further said that ‘my son rarely goes out, he seems to spend a lot of time lying in bed in the mornings and being set in front of the TV (even though he is blind). As he is unable to speak for himself we feel he is often paid little attention. We have made no secret of our concerns since he has been at Linsell house, however with little result’. Mother of a service user – 2 said that ‘management always try to be very helpful, care staff not always so’. And felt ‘ that she was now relieved because her son would be moving to a residential home in another area and the mother do not have to be involved with Linsell house’. All the 3 service users’ who replied to the commissions survey for the question ‘can you do what you want to do’ have said that: Service user –1 said ‘don’t go at as much as I would like to. I like going clubbing and getting things my hair cut in town, I would like to do more of holidays, going to concerts, going to pubs and clubs, shopping. It is good if people take photos of the things I do so I can use these to make choices’ Service user –2 said ‘ my son very rarely goes out, he seems to spend a lot of time lying in bed in the mornings and being set in front of the TV (even though he is blind) as he is unable to speak for himself we feel he is often paid little attention. We have made no secret of our concerns since he has been at Linsell house, however, with little result’. Service user – 3 said he goes to Townsend everyday (except Friday, Saturday and Sunday) sometimes goes to coffee shop at college, have to wait for staffs to say it is OK, I would like to help Kerry in the office do my money. TV is on and keeping him awake. The home was flexible with regard to the choice meals by service users’; the meals are decided in consultations with the service users and their needs. There was no change made to the financial arrangements with regard to the long stay service users’ except, for 3 service users’ whose parents hold their benefits and send in monies as required monthly. The home had revisited service users’ contracts and had made amendments to include information about management of service users’ monies. However, there was no information in the new contracts with regard to service users consent for managing money. The home had mentioned in the pre-inspection questionnaire that a request has been made to commissioning team to initiate agreements in line with mental capacity act. This would offer advocacy to service users’ regarding consent over management of their finances. Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had made appropriate arrangements with external professionals for the delivery and care of the personal and health care needs of the service users’. However, the incident of diarrhoea and vomiting are concerns from preventive measures point of view. EVIDENCE: The manager, staffs, and the service users’ appeared to have good working relationships that enabled service users to freely express their views and receive appropriate care from the staffs of the home. The staffs those who have received medication training carry out the task of administration of medication to the service users’. The home had maintained records pertaining to the administration of medication. The home had made appropriate arrangements with the various external professionals to meet the assessed health and personal needs of the service Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 17 users’. The home had developed additional care plans for service users’ that were specific to individual service users’ which covered sickness, vomiting overnight, diarrhoea, tube blockage, skin care, positioning in bed during gastrostomy feeding, setting the feed, emergency epilepsy management and, medication. Daily records pertaining to hygiene, meals, fluid, urine, seizure, medical issues and social activity records were maintained. There was also separate information about manual handling instructions review dated 08/08/06 and bowel management care plan dated 24/08/06 signed by key worker and by the line manager on 18/10/06. Please refer environment outcome group for details about diarrhoea and vomiting incident and subsequent temporary closer of the respite unit. Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users’ were aware of the complaints procedure and were confident to use the same when necessary. The home had taken appropriate measures on the reported incidents to protect from abuse and neglect and harm of service users’. EVIDENCE: Complaints policy and procedures are now displayed on the notice board of the home. Staffs have been made aware of the policy and procedures. Service users were made aware by the staffs in their interaction, but no record was made available on this inspection to evidence the interaction with the service users’. In response to the commission’s survey, all the 3 service users’ have said that they know who to speak to when they are not happy and were aware how to make complaints. The home had 3 POVA investigations and all the 3 POVA referrals were implemented since the previous inspection. Reported incident of Thursday night; 19/10/06 service user had made a claim that 2 Staff (1 being Agency) had hit his head. Following Police interviews, 1 staff (relief) of the home was suspended and she will not be used again pending the outcome investigation. Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 19 The commission received regulation 37 notification regarding 3 finger print sized bruises noted on a service user’s right arm. Reported through POVA. The home had strategy meeting, the police was not involved, it was considered as a moving and handling issue, and the home had continued to carry on with the regular work. Staff memos were issued and training on moving and handling was undertaken for all the agency staffs. The home had 4-recorded incidents since previous inspection – 2 staffs dismissed in November 2006 with contravention of medication policy. 1 staff member was dismissed in August 2006 for leaving the service user in a wrong position and against the care plan provision. 1 staff member was suspended in March 2006 staff for putting a service user into a wheel chair, when the service user was mobile and this came to the attention of the manager. However, the hearing for this case was due in December 2006 until then the staff was dismissed. All the above issues have surfaced from the poor care practice at the home, which was noticed by the management, investigated and appropriate steps taken. Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home needed to have robust preventive measures in place to avoid any outbreaks at the home. The home needs to have appropriate staff management systems and procedures in place so that the important guideline on infection control was not ignored in the best interest of the service users’ and themselves. EVIDENCE: In response to the recent out break of diarrhoea and vomiting, the home had issued a memo on 28/12/06 to all staffs regarding health and hygiene that included what staffs need to do as part of preventative measures. The home had also circulated a fact sheet about viral gastro-enteritis in residential care, nursing homes, etc. including an infection control guidelines for staff to read, understand and sign. Unfortunately, only 2 staffs from the management and administration section have signed out of 4. Not even a single staff from the 3 Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 21 auxiliary staff signed. Only 2 waking night staffs have signed out of 3. Only 2 staffs have signed from green unit out of 7 staffs’. Only 2 staffs have signed from peach unit out of 8 staffs’. Only 1 staff had signed from the peach unit out of 4 staffs’. The home needs to have appropriate staff management systems and procedures in place so that the important guideline was not ignored in the best interest of the service users’. Environment health officer was informed and the respite unit was disinfected, sterilised, cleaned, and shut until 02/01/07. Please refer to the outcome group’s concerns, complaints, and protection for additional information. There was mixed response from the service users’ to the survey for the questions on ‘is the home fresh and clean’. Service user – 1 said yes, service user – 2 said usually and service user – 3 said sometimes. Some quotes in the words of a service users’ regarding the cleanliness: ‘ sometimes there is food and drink on the table in the lounge – until staff wipe it up after meals, everywhere else is clean. When it is a nice day, I like to have my bedroom window open to let the air in’. The home carried out a fire drill on 19/09/06 and recorded in the result that 2 staffs remained in the building unaware of the fire procedures. The home need to help aware all the staffs with necessary fire drill procedures and safety. The home had refurbished respite bathroom and peach bathroom including the showers. The green bungalow was redecorated and new alarm call system was updated. The home now had completed refurbishment of the bathroom with a new bath, shower, and changing table. This was achieved in March 2006. The respite unit also had bathroom refurbished with new shower, changing facility, this was achieved in May 2006. Currently, the home was planning to refurbish the bathroom in the long stay unit – green bungalow and this likely to happen in financial year 2007 - 2008. Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 22 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home had deployed inadequate staffing levels with poor skill mix, staffs’ supervision were irregular, and had little continuity of staffs’ that had no positive impact on the service users’ quality of life goals. EVIDENCE: The home had experienced high staffs’ turn over compare to the previous inspection years. Since the previous inspection in all 11 staffs have left for various reasons. However, what is glaring is the fact that 4 staffs have been dismissed for various reasons. The staff deployment rota indicated that the home had more temporary agency staffs as compared to a small percentage of permanent staff. The home was using staffs’ from 3 different agencies for care staff, domestic/laundry, and cooking. Currently, the home had been using high number of agency staff – this was being done on a regular day-to-day assessment basis – agency staffs have been given induction and various trainings. The home had maintained a Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 23 list of 38 temporary agency staffs’ of which, there were 30 residential workers. On this inspection it was found that the home had used 20 different staffs’ from agency during the months February 2006 to December 2006. Of which only 2 staffs had received moving and handling training and only 5 staffs’ records were verified as on this inspection day. However, the agency profile audit was yet to be completed. The pre-inspection questionnaire had indicated that all staffs including agency staffs received CRB clearance and a senior manager was in the process of completing staffing profile audit to ensure the home hold all the relevant information on site, either at Linsell or at the county hall. The home had put out an advert for residential workers – 10 permanent posts, both bench mark and trainee post, 15 applicants have been short-listed for interviews to take place on 17, 18 and 22 January 2007. The home currently had about 7 staffs with NVQ3, 1 NVQ registered manager and 1 NVQ4, 1with NVQ2, and 2 staffs had NVQ1. The home had provided information on staffs training, which included induction, moving and handling and escort services. The home had also planned to carry out the following trainings for the staffs’ in the forth coming months, which included induction, POVA, epilepsy awareness, race and culture training, moving and handling refresher, team teach, medication, health and safety, risk assessment, food hygiene and first aid. The home had organised parent careers meeting on the 13/07/06 and 14/07/06 the key issue raised was` about the staffing levels and continuity of care to the service users’ as the home had more number of agency staffs. The senior managers have assured the parent carers that the staff recruitment was in the process. Staffs’ supervision has been one of the key concerns at the home, to overcome the issue of regularly carrying out staffs’ supervision; the home had introduced open days. However, open days cannot be an alternative to staffs’ supervision as part of learning and development of staffs’ knowledge and skills including improving service delivery. There were mixed responses from the service users’ to the survey for the questions ‘do the staff treat you well’. 2 service users’ have said yes sometimes and 1 service user had said yes usually. Some quotes in the words of service users for the question ‘do the carers listen and act on what you say’: Service user –1 said ‘if staff are busy they don’t always come straight away when I shout them, staff try to listen tome and sometimes act on it – if they can’t do things it is important to me that they come back and explain why not. Sometimes if staff are very busy they can forget things. Service user – 2 said ‘management always try to be very helpful, care staff not always so, Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 24 Service user – 3 said ‘some staff are nice, sometimes I doesn’t like being ignored’. Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 25 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home manager had maintained good working relations with the service users’ and their family members, staffs and relevant professionals which had been useful for appropriate care delivery and in meeting the service users’ assessed needs. However, the issues of staffing and environment have been a cause of primary concern for service users’ achieving quality of life goals. EVIDENCE: The home has had difficult time coping with various incidents that have been reported under various outcome groups of this report, which included, poor staffing and health and safety of staffs and service users’. The senior management appeared to have taken adequate steps to resolve the situations for details please refer respective outcome groups of this report. However, the Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 26 home need to address on priority the outstanding requirements and recommendations. The commission had received the completed pre-inspection questionnaire on the 15/01/07. The home reported to have inspected the following areas of service and implemented recommendations: which included fire equipment, fire drill, weekly fire alarm test, environment health officer, gas installation, central heating system, water temperatures, emergency lighting, hoists, lift, emergency call system, COSHH, oxygen storage and beds. The home had also mentioned that the policies and procedures were reviewed and updated annually. However, the policy on bullying was being implemented from November 2006. The home had developed business and financial plan for the year 2005/2006 which included a structured format for registered provider quality assurance for the regulation 26. The plan covered areas such as management information, staffing, communication systems, training and development, financial protection, national care standards, service users issues – concerns compliments and complaints, conduct and management of the home service information, health & safety, service users case files and changing needs, service users representatives comments, and contact with staff during inspection. The home had also developed a structured questionnaire for the respite service. The purpose of the questionnaire was to receive feedback from the service users’ families/careers to identify and improve the service delivery. The home needs to adhere to the monthly quality assurance planned process and complete the respite service survey and identify areas of improvement and introduce change that could help achieve the quality of life goals of service users’. Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 27 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 Standard No Score 1 3 2 1 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 25 26 27 28 29 30 2 1 X 1 X 1 X X 3 X X 1 X X LIFESTYLES Standard No Score 11 X 12 3 13 1 14 X 15 3 16 3 17 STAFFING Standard No Score 31 X 1 X 1 2 1 1 X 1 2 1 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000032470.V294857.R01.S.doc Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Linsell House Score 1 2 3 X 2 X 3 X X 2 x Version 5.2 Page 28 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. YA2 Standard Regulation 15 (1) Requirement The home must complete all sections of the care plan, enable service users and key stakeholders’ participate in the development of the plan. The home must revisit social activities and make improvements to suit the needs of the service users’. The home must explore ways of encouraging participation of service users in decision-making process that would help them achieve quality of life goals. Timescale for action 31/03/07 2. YA13 16 (2) (m) 15/03/07 3. YA9 12 (2) 31/03/07 4. YA24 13 (3) & 4 5. YA30 13 (6) The home must have robust 15/01/07 preventative measures in place and have a robust internal monitoring mechanism to avoid any outbreaks at the home. The home must have appropriate 15/01/07 staff management systems and procedures in place so that the important guidelines like the infection control were not ignored in the best interest of the service users’ and themselves. DS0000032470.V294857.R01.S.doc Version 5.2 Page 29 Linsell House 6. YA32 7. YA36 18 (1) The home must have adequate staffing levels with appropriate skill mix and ensure their continuity. The home must regularise staffs’ supervision as part of learning and development of staffs’ knowledge and skills including improving service delivery, to have positive impact on the service users’ quality of life goals. 15/02/07 18 (2) 15/01/07 8. YA7 15 (2) The home must have appropriate 28/02/07 arrangements for reviewing the care plans and reflecting the changing needs of individual service users’ care plans regularly. The home must complete staffing profile audit to ensure the home hold all the relevant information on site. The home must provide levels of permanent staff to ensure personal support to be delivered in a way the Service users prefer. 01/05/06 15/01/07 9. YA34 19 10. YA18 12 15/02/07 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 YA6 Good Practice Recommendations The home should enable service users’ and their family members to know the service users’ assessed and changing needs and personal goals are reflected in their individual plan. The home should ensure the continuity of staffs’ to meet DS0000032470.V294857.R01.S.doc Version 5.2 Page 30 2. Linsell House YA19 3. 4. 5. YA35 YA37 YA42 physical and emotional needs of the service users’. The home should continuously upgrade the skills of staffs’ by appropriate trainings to meet the individual and joint needs of the service users’. The home manager should ensure that staffs’ pay attention and follow guidelines and memos issued by the management. The home manager should further make improvements with regard to the health; safety and welfare of service users are promoted and protected. Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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. Extracts may not be used or reproduced without the express permission of CSCI Linsell House DS0000032470.V294857.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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