Inspection on 03/09/07 for Linsell House

This inspection was carried out on 3rd September 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. 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 14/01/09

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

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 Ian Dunthorne Unannounced Inspection 3 September 2007 11:00 rd Linsell House DS0000032470.V348076.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.V348076.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.V348076.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.V348076.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 (Long stay) (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 28th December 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. Parking is to the front of the property, and a fair sized garden surrounds the buildings. Linsell House DS0000032470.V348076.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over eight hours during the morning, afternoon & early evening and it was unannounced. Prior to the inspection time was taken to review the information gathered since the last inspection and plan this inspection visit. This report also includes feedback from relatives and visitors obtained from postal surveys. The inspection included a tour of the communal areas and several bedrooms, inspection of certain records, discussion with staff and the manager, discussion with people who used the service, their relatives and observation of the routines of the home. The method of inspection was to track the lives of several people who used the service. This was done by speaking to them about the service they receive, observing their life in the home, talking to staff and relatives and reviewing their records. What the service does well: What has improved since the last inspection? Information prepared by the home about people who used the service had been reviewed at intervals. The home and staff supported the people who used the service to pursue meaningful leisure activities, relationships & community links. The home had introduced some ways to help improve and ensure people who used the service were involved in making choices and decisions about their lives. Infection control policies and practices within the home had been reviewed and some improvement measures implemented, to help safeguard people who used the service, staff and anyone visiting the home. Staff were supported by receiving regular supervision. Linsell House DS0000032470.V348076.R01.S.doc Version 5.2 Page 6 Suitable individual records for both permanent and agency staff were held at the home in the form of personal profiles. What they could do better: Some of the things that the home could do better include: ~ Making sure there are enough permanent staff employed, to ensure that people who use the service are supported in a way they prefer. ~Involving people who use the service or their relatives, representatives or advocates as necessary, in preparing information about them, to help the home meet their needs. ~It was disappointing to find that the home continued to rely heavily on the support of agency usage, as opposed to the recruitment of its own permanent staff. This in turn impacted negatively on consistency in regular staff provision for people who used the service and placed additional pressure on existing staff. This was a requirement at the last inspection, which the home had failed to comply with. ~ Ensuring all staff attend training in preventing abuse, to help them know how to identify and protect customers from potential abuse or harm. ~ Providing training for staff, which would help them understand and meet some of the specialist needs of the customers. ~ Making sure that people who use the service are clear about anything they will have to pay for and that they or their representative as necessary, signs the contract to show their agreement with it. ~ Assessing, monitoring and reviewing the health and diet of people who use the service. ~Ensuring that medication is properly looked after and with the agreement of those people who use the service and are supported by the home with their medication. ~ Making the home a pleasant homely place to live throughout. Linsell House DS0000032470.V348076.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Linsell House DS0000032470.V348076.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.V348076.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, 2, 4 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provided generally sufficient information for prospective people who may use the service, however it sometimes failed to identify the fees payable, which did not allow all people to be aware of the fee and what they may need to pay, including that of any additional extras. EVIDENCE: The service’s statement of purpose and service user guide had been reviewed in December 2006 and they were available in a suitable format for some of the intended people who used the service and provided information to enable prospective people to make an informed choice about whether to stay. Both contained the necessary information required; however fee information was absent. Relatives who were spoken with as part of the inspection supported that evidence. The homes last inspection report was available within the home, however it was not displayed or made publicly accessible in any way. No new prospective people to use the service had been admitted since the last inspection. Therefore this standard could not be fully assessed. However there was evidence included within the records of the people whose lives were tracked, which supported that the home had undertaken an assessment of Linsell House DS0000032470.V348076.R01.S.doc Version 5.2 Page 10 needs for each of them. The needs assessment was also supported by a health and social services assessment. The home had developed a care plan from the assessment of needs. The home demonstrated that the method and system for doing so provided a satisfactory form of assessment. The method of assessment involved the person who used the service, the family and other individuals referred to as part of the person who used the services, care management process, however this had not always been acknowledged with evidence by asking them to sign this information. The needs assessment of a prospective person who will be using the service, currently being introduced to the service by a succession of tea visits, had been recently completed and was examined and found to be satisfactory. The records of customers examined verified that introductory visits took place and it was evident that the service considered them a very important part of the transitional process for beneficial, successful and supportive respite stays. The service began introductory visits initially at the pace of people who used the service, in the form of tea visits and built upon this as a starting point for the transition. Each person who used the service had an individual contract, however they or their relative, representative or advocate as necessary had not signed some, to acknowledge their consent and agreement. There was evidence that the home had introduced contracts in a format appropriate for the needs of most of the people who used the service. The home had failed to include fees charged within the terms and conditions and it did not include the cost of any ‘extras’ that may not be included within the fee. Linsell House DS0000032470.V348076.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 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Risk assessments were completed by the home, to ensure people who used the service were protected whilst their independence was promoted. However further development was needed to ensure that the person who used the service, agreed to their risk management strategy, by ensuring their involvement and consultation are recorded. EVIDENCE: A sample of care plans and supporting documentation for people who used the service were examined and found to contain suitable and sufficient information to help meet their changing needs and personal goals were identified and reflected in their individual plan. The home was in the process of introducing a new person centred planning approach and one person who life was tracked provided suitable evidence of this and in addition, the plan had also been produced in a picture format suitable for the person who used the service to understand. A suitable keyworker was allocated for each person who used the service and lived at the home. The plans had been reviewed at regular Linsell House DS0000032470.V348076.R01.S.doc Version 5.2 Page 12 intervals, however there was not always clear evidence that people who used the service had been included and consulted in drawing up the plan. One relative spoken with during the inspection, who had attended the review of the care plan of their relation who used the service that day said, “the care plan is reviewed regularly and I am always involved, the keyworker is very good, she always keeps me updated”. Despite this, the home often failed to ensure they obtained recorded evidence of the involvement of the person who used the service and their relative or representative as necessary. In some cases there was evidence of advocacy service consultation and support. Most respondents to the postal surveys said they were usually supported by staff to make their own decisions about what to do each day. There was evidence from observing people who used the service and records examined that they were assisted as necessary to make decisions about their daily lives. Some information provided by the home was in a suitable format to support people who used the service to make decisions about their lives at the home. People who used the service and lived at the home were supported by staff to participate independently and confidentially in an advocacy service provided if they wished, when they visited. Staff were observed communicating in ways appropriate to each individual person who lived at the home and enabled them to make an informed decision in a way that person could understand. One relative spoken with said, “staff communicate very well with the people who live here”. Regular meetings were held within the home for people who lived there and used the service, which provided a useful forum for them to be supported by the home to make decisions about their lives there. The meetings format had also been produced in a pictorial format, to enable more people who used the service to participate and understand for those whom this format was suitable for. There were generally suitable risk assessments in place as part of the homes risk assessment strategy to enable people who used the service and who lived at the home to take risks supported by staff and they had been regularly reviewed in association with person centred planning process, which were examined. However, there was not always evidence that the risk assessments had been agreed in consultation with person who used the service by signing them on the document used at the home. In addition the home’s risk management process with regard to the use of bed rails was unsatisfactory at the time of this inspection. However it is understood that any concerns raised during the inspection were rectified immediately. Staff spoken with described risk management strategies and information which they were initially provided with as an introduction within their inductions and were able to explain how they identified and minimised risk to support people who used the service. Linsell House DS0000032470.V348076.R01.S.doc Version 5.2 Page 13 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, 14, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home and staff supported the people who used the service to pursue meaningful leisure activities, education, relationships & community links. However further development was required, to ensure that the nutritional needs of people who used the service were assessed, monitored & reviewed to ensure that their health and wellbeing was maintained. EVIDENCE: The home was exploring educational options and availability with local colleges for people who lived at the home and had identified this as an area in which they intended to improve. People who lived at the home were supported to maintain contact with the local community through local resources and an effective staff keyworker system. Those people who used the service who wished to were supported by staff to attend their local religious worshipping facility, if and when they wished Linsell House DS0000032470.V348076.R01.S.doc Version 5.2 Page 14 to. Several people who used the service were supported by their keyworker to access local services regularly; talking with staff and examining records maintained by the home supported this evidence. Fluctuating staff levels and high agency usage can impact negatively upon the level of flexibility and support, which the home is able to provide people who use the service, sometimes. See ‘Managers & Staff’ section of this report. People who used the service were supported by the home to pursue their own interests and hobbies. Some people who used the service had been supported by staff at the home on several recent activities, which those people had chosen to and included, greyhound racing a theatre visit and lunches at local restaurants. The home maintained records of support provided for people who used the service. Several people who used the service had chosen to go on holidays with staff support, which had been booked. During the inspection, an aromatherapist attended the home to see some people who lived there. However there was evidence that to support many people who lived at the home to pursue their interests, many staff chose to work additional hours. There was evidence that the home supported people who used the service to maintain family links and friendships inside and outside the home, in accordance with their wishes. People who were spoken with during the inspection and who also said that their families and friends could visit at any time supported this evidence. This evidence was supported by the service user plans, which included personal relationships. Staff were observed using the preferred names of people who used the service, as recorded in their care plan and speaking with them by involving them and not just to each other. People who used the service were observed sitting where they liked and moving around without restriction. However, staff were observed undertaking most household tasks and there appeared to be limited involvement and encouragement of people who lived at the home. Staff were observed knocking on bedroom doors of people who lived at the home before entering and waiting to be invited into their bedrooms. Evidence examined, which included the menus, demonstrated that people who used the service enjoyed well prepared and presented, home cooked and appetising food, in suitably sized portions. The menu choices were about to be introduced in a revised and suitable format for people who used the service to make an informed choice and decide what they would like to eat. The new menu’s had been produced as effective visual tools to enable customers to have choice in most aspects of their meals. Due to unsatisfactory staff recruitment levels see ‘Managers & Staff’ section of this report, there was no cook for teatime on the day of the inspection. Therefore the home had improvised and asked the people who lived at the home what they would like for tea from local take aways, which transformed the tea into an enjoyable event. Linsell House DS0000032470.V348076.R01.S.doc Version 5.2 Page 15 There was evidence that not all nutritional needs of people who used the service were being assessed at regular intervals, therefore risk factors associated with weight change were not being monitored. Linsell House DS0000032470.V348076.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, 20 & 21 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had a suitable medication policy and staff had received satisfactory training in medication administration. However the delivery of the medication systems within the home required some improvements, to safeguard the wellbeing of people who used the service, to prevent placing them at potential risk. EVIDENCE: The home failed to ensure that people who lived at the home were supported in a way they preferred, due to limited numbers of permanent staff, which impacted directly on the personal support they received. The manager acknowledged this and commented in information provided to CSCI, that the home needed to provide people who live at the home more choice regarding who supports them on a daily basis and that an area for improvement over the next twelve months for the home was to recruit more permanent staff. This was a requirement at the last inspection, which the home had failed to comply with. Linsell House DS0000032470.V348076.R01.S.doc Version 5.2 Page 17 These concerns were reflected and supported by postal survey respondents completed by relatives of people who lived at the home and staff who were spoken with. One respondent to a postal survey commented, ‘The staff are always open and polite, some agency staff look a little lost and not given much to do when we see them. They are usually just sitting in the lounge and watching TV with clients and they do not get up and help sometimes’. There was a keyworker system in place within the home, to provide more effective personal choice and support for people who used the service. However the success of the keyworker system was limited to and affected by the level of permanent staff employed. Staff members spoken with said that they were placed under additional pressure as their keyworker responsibilities were greater than usual, as agency staff do not adopt the keyworker role, subsequently permanent staff have more keyworker responsibilities to cover. People who used the service were unable to choose their own GP’s (General Practitioner’s) and the manager acknowledged that this was an area for improvement already identified and to be addressed by the home. Health action plans had not yet been introduced by the home, however some staff had recently received the necessary training to implement these. There was evidence that the home accessed outside healthcare professionals and services as required; in order to support and meet the healthcare needs of the people who used the service and lived at the home. A variety of healthcare monitoring charts were in use. Samples of medication records, storage and procedures were checked, of those people who used the service whose lives were being tracked as part of this inspection. Staff administering medication was observed in part. Staff had received satisfactory training in medication administration, the training did not extend to agency staff who were therefore unable to administer medication, which placed additional pressure, complication and consideration to rota’s of existing trained permanent staff, to ensure medication trained permanent staff were on duty on each shift every day. No people who used the service were responsible for administering their own medication within the home. There were no records to demonstrate that people, who used the service or their representative as necessary, had consented to the home undertaking the administration of their medication. The homes procedures for the administration of medication in some areas required some improvements, to reduce the potential risk of errors taking place and therefore placing people who used the service at risk. The homes medication policy, including the training policy had been reviewed and revised in March this year. The home had one notifiable medication incident since the last inspection, which was investigated and concluded satisfactorily. There were no people who used the service being supported with the administration of any controlled medications, at the time of the inspection. However, the register was examined and found to be unsuitable for its Linsell House DS0000032470.V348076.R01.S.doc Version 5.2 Page 18 purpose, although the records kept were satisfactory. It is understood that the home has since purchased an appropriate item for controlled medication recording. The homes methods for stock rotation of medication were unsatisfactory and several medications were found to be out of date and beyond the individually labelled expiry dates. The medication administration records (mar) were fully completed and no gaps were found when entries should be made. Some handwritten amendments had been made by the home, on the ‘mar’ sheet to the frequency of administration of the medication for one person who used the service. However there was no evidence to support that this had been done in consultation and in agreement with the GP. There was evidence that the home had failed to date topical creams that staff supported people who used the service to apply when they had opened them, to enable them to identify the ‘shelf’ life’ once opened clearly. The home had good death and dying policies. The home had discussed the wishes of people who used the service in the event of terminal care and death; the family of people who used the service and friends had been involved in planning for this. This information had been documented. Linsell House DS0000032470.V348076.R01.S.doc Version 5.2 Page 19 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 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service had satisfactory complaints and adult protection procedures in place, which ensured that complaints were listened to and people who used the service were safeguarded from abuse. However some staff had not received ‘Safeguarding Adults’ training, which could place people who used the service at possible risk of harm or abuse. EVIDENCE: The home had a satisfactory complaints procedure that ensured people who used the service felt their views were listened to and acted upon. The complaints procedure was produced in a format appropriate for people who used the service to understand and access. There had been no complaints since the last inspection. Two thirds of postal survey respondents said they knew how to complain and felt that staff listened to them and acted on what they said. There was a complaints file used by the home, which was examined and there was evidence of suitable records kept. The home had a Safeguarding Adults policy in place, which included whistle blowing and staff spoken with demonstrated they were aware of the procedure. Not all staff had attended Safeguarding Adults training within a reasonable timescale from the start of their employment, some staff spoken with said they had been nominated for training and this was supported by the manager’s explanation, who explained that the access to training provided by the local authority was based on a ‘rolling’ program, therefore staff had to wait until the Linsell House DS0000032470.V348076.R01.S.doc Version 5.2 Page 20 next available training opportunity arose. In reality this proved to be some time as one staff member had been waiting so far for five months. However there was evidence to support that the manager had included an introduction to safeguarding adults as part of new staffs induction process. Staff spoken with were able to give good common sense answers when asked what they would do, if they observed what they considered to be an alleged incident of abuse. Since the last inspection there had been two notifiable incidents in accordance with the ‘Safeguarding Adults’ policy and guidance, which was reported to CSCI (Commission for Social Care Inspection) at the time. Evidence examined, supported a process that had been followed to safeguard and protect people who used the service. The homes policies and practices regarding handling money of people who used the service and financial affairs were generally satisfactory and protected people who used the service from abuse. Money held by the home for two people who used the service whose lives were tracked, was checked and balanced with the records held. The money was stored safely and individually for each person. However a witness signature had not been obtained for all financial transactions carried out on behalf of people who lived at the home, whose money they looked after. There was evidence that the manager made regular checks as part of an audit process of financial transaction records and balances, to ensure appropriate practices were being maintained. Linsell House DS0000032470.V348076.R01.S.doc Version 5.2 Page 21 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 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There were identified risks and a poor standard of décor in some areas of the home and the ‘tiredness’ in some areas of the building detracted from the homeliness of the environment. There was little evidence of improvement through maintenance or future planning. EVIDENCE: The home provided a purpose built, environment for people who used the service. The home was close to local amenities and transport if required. There was evidence that the environment had not been well maintained and was in a poor state of repair generally & decoratively in several communal areas and that as a result a program of refurbishment and maintenance had been discussed, but no definite, confirmed future plans to address the concerns had been made. Evidence of the concerns were demonstrated by some corridor doors which were bare wood in part, several unsafe and / or broken communal area chairs provided for people who used the service, which were generally observed to be very worn with limited quality due to their obvious age, several Linsell House DS0000032470.V348076.R01.S.doc Version 5.2 Page 22 light fittings with clearly absent lamp shades in corridors and communal areas, an absence of blinds and / or curtains in areas which would have clearly benefited from them for security and privacy purposes and severely marked paint work in many areas throughout the home. Some staff members spoken with said they had worked at the home for several years and were not aware of the communal areas ever being redecorated. There was evidence in some areas of health & safety concerns, see ‘Conduct & Management of the Home’ section of this report. The manager said there was no provision for confidential meetings within the home, which was the explanation provided for a review of support for someone who used the service conducted by a visiting professional was observed being held in a communal lounge area. Toilets and bathrooms were safe and suitable for their intended purpose and were in appropriate locations. Each were lockable and maintained the privacy of people who used the service, however staff were able to override this feature in an emergency. The decoration in some toilets and bathrooms appeared ‘tired’ and in need of redecoration. It was understood from the manager the local Environmental Health Office had undertaken an inspection within the past two weeks and that the verbal outcome provided at that time was allegedly a positive one, however they were waiting for the final report to confirm this. The home appeared clean and generally free from offensive odours. However in one bathroom there was evidence supporting the potential use of communal toiletries for people who used the service, a wooden table and some incontinence materials stored inappropriately lying on a shelf which were not effective infection control measures. CSCI had been notified of one infectious outbreak since the last inspection, evidence supported effective infection control practices implemented at the time by the home to prevent further spread of the infection. A revised infection control policy had been introduced by the home, together with other healthcare national guidance and there was evidence that staff had read and signed the policy to acknowledge this. The manager was a member of a local authority infection control working party, who were responsible for developing and implementing a new infection control procedure. All postal survey respondents stated that they found the home always to be fresh and clean. Linsell House DS0000032470.V348076.R01.S.doc Version 5.2 Page 23 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, 33, 34, 35 & 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Only limited progress has been made in addressing permanent staff shortages and as a result people who use the service do not receive consistent care. EVIDENCE: Staff spoken to identified varied training which they had undertaken at the home and this was supported by evidence in their training records. There was evidence that some staff had received specialist training to support them to meet the needs of people who used the service. One relative said, “the staff here have the skills to manage any challenging behaviour”. The percentage of staff qualified at nvq (national vocational qualification) level 2 or 3 was above the required minimum level and demonstrated a satisfactory number of qualified staff. Staff were observed and spoken with and were able to demonstrate they possessed a satisfactory understanding, knowledge and specialist skills to meet the needs of individual people who used the service. As detailed in other sections of this report, staffing levels were only maintained by utilising high levels of agency usage, which was negatively impacting upon Linsell House DS0000032470.V348076.R01.S.doc Version 5.2 Page 24 the continuity and consistency of service for people who lived at the home and used the service. The home had failed to address this adequately; this was a requirement at the last inspection. The home had several vacant permanent positions, which it had recently recruited to, however the local authority had suspended their applications and frozen the posts. The reasons provided for freezing the positions, preventing the home from recruiting new permanent staff, was that the local authority were reviewing the entire staffing structure. Consequently the home had been prevented again from improving their difficulties in recruiting an adequate level of permanent staff, subsequently this continued to have an unacceptable detrimental impact on this home, the effectiveness of the staff team and support provided for people who used the service. There was evidence that staff meetings took place and were recorded. Staff were being recruited according to County Council policies and procedures. Staff vetting documents were being held centrally and arrangements were not made to examine them as part of this inspection. However it had been previously agreed that proformas would be compiled and kept in each service for all existing county council staff. Staff proformas that were examined, demonstrated that the home had obtained satisfactory checks and clearances on staff before their commencement, therefore the home was able to demonstrate that people who used the service were protected by the home’s recruitment policy and practices. The home was using staff from an agency to supplement the existing staff team. Profiles were received for all external agency staff prior to working at the home, demonstrating that checks were made on the external agency staffs’ suitability, several were examined and found to be suitable and comprehensive during the inspection. Records of staff training & development were examined and identified a suitable induction process, which was supported by staff spoken to and included LDAF (a specialist induction program for staff supporting people who used the service with a learning disability), a corporate induction and work based induction. There was evidence examined as part of the supervision process that staff’s training and development was discussed. However there was no evidence that the discussion extended to the production of an individual specific training and development plan. Staff spoken to and records examined, provided evidence that staff received regular supervision and annual appraisals. Linsell House DS0000032470.V348076.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, 38, 39, 41 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some aspects of the homes health & safety and safe working practice procedures needed further development to ensure service users & staff would be protected from the risk of harm. EVIDENCE: The registered manager Geraldine O’Neill was present throughout the inspection. The manager said that she had achieved a BTEC in social care and completed the Registered Managers Award. The manager was observed to communicate effectively with both people who used the service and staff and appeared approachable. People who used the service and staff who were spoken to supported this view. The home had an inclusive atmosphere. The manager of the home maintained an effective Linsell House DS0000032470.V348076.R01.S.doc Version 5.2 Page 26 leadership ethos that both people who used the service and staff were able to benefit from. The manager said that regular meetings were held with people who used the service their family and friends of the home, although evidence of this was not examined. In addition records of parents / carers meetings held recently were examined. The home had developed a quality assurance and monitoring system, from which the home had developed an action plan from the information it had collected from several sources. There was evidence that the home had begun a cyclical system of regularly monitoring and reviewing the views of people who used the service, amongst others. However further development was needed to ensure that the annual development plan was reviewed and the results updated regularly. The home kept up to date records in the form of individual property inventories for people who used the service, there was evidence that keyworkers ensured these were reviewed and updated at regular intervals. Some aspects of the homes health & safety safe working practices, required some improvements to protect people who used the service from potential risk or harm. See ‘Environment’ section of this report. Some areas were demonstrated by unsafe and broken furniture, unsafe electrical fan use and food hygiene practices were not always being consistently being maintained by staff. Insufficient staff numbers were trained in safe food hygiene practices. Various records were examined to support adequate compliance with safe working practices, regarding health & safety including generic risk assessments for the home and various tasks. The home used a system of generic ‘Control of Substances Hazardous to Health’ (COSHH) risk assessments. Linsell House DS0000032470.V348076.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 2 2 2 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 2 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 3 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 2 3 2 3 2 X 2 2 X Linsell House DS0000032470.V348076.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 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. Previous timescales of 31/03/07 met in part. Timescale for action 31/10/07 2. YA5 5 (1b) & (1c) 30/11/07 Each person who uses the service must be provided with an individual written contract or statement of terms & conditions, which must include the amount and method of payment of fees. The person who uses the service, or their representative as necessary and the manager must sign the contract. People who use the service must have their nutritional needs assessed by the home and reviewed at regular intervals, including risk factors associated with weight. The home must provide levels of permanent staff to ensure personal support to be delivered in a way the Service users DS0000032470.V348076.R01.S.doc 3. YA17 12 (1) (a) & 13 (4) (c) 31/10/07 4. YA18 12 31/10/07 Linsell House Version 5.2 Page 29 prefer. Previous timescales of 01/05/06 & 15/02/07 not met. 5. YA20 13 (2) The home must make arrangements for the safe handling, recording, administration, safekeeping and disposal of medicines within the care home. Training on the prevention of abuse must be given to all staff to ensure customers are protected from abuse. A programme of maintenance must be provided and implemented, to include the plans for renewal of the fabric and decoration of the premises where a need is identified. The home must have adequate staffing levels with appropriate skill mix and ensure their continuity. Previous timescales of 15/02/07 met in part. 31/10/07 6. YA23 13 (6) 31/10/07 7. YA24 23 30/11/07 8. YA33 18 (1) 30/11/07 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 YA1 Good Practice Recommendations The homes most recent inspection report should be made available to both people who use the service and their families. The home should enable people who use the service and their family members with their agreement to know their DS0000032470.V348076.R01.S.doc Version 5.2 Page 30 2. YA6 Linsell House assessed and changing needs and personal goals are reflected in their individual plan. 3. 4. YA9 YA12 Risk management strategies should be agreed with the person using the service and this should be recorded. The home should make arrangements to enable people who use the service, to have the opportunity to continue their education if they wish to. The home should ensure the continuity of staffs’ to meet physical and emotional needs of the service users’. Health care & physical needs should be included in health action plans once implemented. Bottled liquid medications, ear / eye drops, creams should be dated when opened to accurately initiate date life once opened. Where the home handles money for those people living at the home, a witness signature should be obtained for each financial transaction record and the purpose of this clearly explained to the witness. Communal toiletries, wooden furnishings and inappropriately stored incontinence materials should not be provided or used in bathrooms, to ensure effective infection control practices are not compromised. The Department of Health’s publication ‘Infection Control in Care Homes’ guidance should be sought and implemented for guidance purposes, to compliment and support any existing policies and procedures already in place. The home should ensure that it has a training & development plan, which includes a training & development assessment for the staff team as a whole, which then extends to staff individually. The home manager should further make improvements with regard to the health; safety and welfare of people who use the service, to ensure they are promoted and protected at all times. 5. YA19 6. YA20 7. YA23 8. YA30 9. YA35 10. YA42 Linsell House DS0000032470.V348076.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.V348076.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. Re-publishing this information is in breach of the terms of use of that website. 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