Inspection on 09/10/07 for Linton Lodge

This inspection was carried out on 9th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Linton Lodge 22/05/06

Linton Lodge 22/02/06

Linton Lodge 30/09/05

Linton Lodge 11/01/05

Linton Lodge 21/10/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Linton Lodge 97 Forburg Road Hackney London N16 6HR Lead Inspector Robert Sobotka Unannounced Inspection 9th and 17th October 2007 09:00 Linton Lodge DS0000010275.V354077.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 Linton Lodge DS0000010275.V354077.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. Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Linton Lodge Address 97 Forburg Road Hackney London N16 6HR 020 8806 5343 077 1114 3323 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) Mrs Florelda Willis-Barnes Mrs Florelda Willis-Barnes Ms Florelda Willis-Barnes Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd May 2006 Brief Description of the Service: Linton Lodge provides 24-hour residential care for six people with learning disabilities. The home is located in a quiet residential road off Clapton High Road. It is easily accessible to Clapton, Stamford Hill and Stoke Newington British Rail links and shopping areas. The home is well served by bus routes on Clapton Road. Unrestricted on street parking is available. The property is a large, comfortable, homely Victorian terraced house with many original features. All service users have their own rooms with hand washbasin. On the day of the inspection the home was fully occupied by 6 service users. Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The first day of this inspection took place on 9th of September 2007 and the visit was unannounced. As the registered manager was not available on that day and the inspector was unable to access some of the records needed in order to assess whether previous requirements have been met, the inspector came back the following week on 17th of September to continue with this inspection. As part of the inspection process, the registered manager/proprietor was asked to complete an Annual Quality Assurance Assessment. The document was sent out to the home on 31st July 2007. The proprietor failed to return a completed document within specified time and a reminder letter was sent out on 10th of September 2007. During this inspection, the proprietor assured the inspector that she would return the document to the Commission by 26th of October. As the registered manager failed to return the AQAA, the inspector then telephoned the home to chase up a return of the document. An extension was granted to the home to return it by 19th of November. As the registered manager once again failed to supply the Commission with the document, the inspection process was closed on 19th of November and a statutory requirement has been issued within this report to ensure that the registered manager returns a completed AQAA to the Commission within the set timescale. During both visits to the home the inspector spoke to several service users and staff working to the home. He also carried out a tour of premises and viewed various records. The purpose of this visit was to assess the home’s compliance with the Care Homes Regulations. The inspector would like to thank service user and staff who contributed to this inspection process. What the service does well: People who use the service benefit from a homely and hygienic environment. They are supported to attend a wide range of activities. Family links and friendships are encouraged and supported. Complaints appeared to be appropriately dealt with. Those living in the home are involved in a day-to-day running of the home. Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Following this inspection several enforcement notices will be issued to the registered manager in order to secure compliance with the Regulations. In addition, the following requirements have been made during this inspection visit and/or have been repeated from previous inspection visit. - The registered manager must ensure that staff work in line with any visa restrictions in place - The registered manager must ensure that all staff completed mandatory training. - The registered manager must ensure that all service users have signed contracts in place. - The registered manager must ensure that individual care plans are reviewed and evaluated at least six monthly and updated to reflect changing needs. - In order to maintain appropriate risk management systems in the home, the registered manager must ensure that risk assessments are reviewed on a regular basis. - The home’s statement of purpose must be updated to include correct details of the local authority in relation to handling any adult protection issues. - In order to monitor service users weight, the registered manager must ensure that where it has been identified, a record of weigh in respect of individual service users is maintained in accordance with their individual care plans. - The registered manager must ensure that any unused medication is returned to the pharmacist for safe disposal, in order to maintain appropriate medication systems in the home. Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 7 - The registered manager must ensure that the home’s complaints policy is reviewed and the statement that “all complaints will be treated with complete confidentiality” is removed, in order not to mislead a complainant. - The registered manager must ensure no loyalty cards are used when making purchases on behalf of a service user, unless the cards are in the service user’s name, in order to protect the service user from financial abuse. - The registered manager must ensure that a copy of the duty roster of persons working at the care home is maintained, and a record of whether the roster actually worked, in order to demonstrate staff appropriate staffing levels and management support is in place. - The registered manager must ensure that a completed Annual Quality Assurance Assessment is returned to the Commission. The following 3 good practice recommendations have also been made: - It is recommended that Health Action plans be updated with the actual dates of annual checks completed/due. - In order to allow easier auditing of expenditures made of behalf of service users, it is recommended that all receipts be kept in order and numbered. - It is recommended that the registered manager formalise feedback from professionals, service users and families with regard to their satisfaction by implementing a system to record feedback with regard to the service provision. 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. Linton Lodge DS0000010275.V354077.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 Linton Lodge DS0000010275.V354077.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, 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information they need to make an informed choice about where to live. Staff working in the home appeared to be aware of service users’ needs and what assistance is expected to be provided to service users. The new contracts required signing, as previously requested. EVIDENCE: As part of this visit, the inspector viewed the home’s statement of purpose. It covered the home’s aims and objectives, how referrals should be made, general information about the home and its complaints systems. The home’s current statement of purpose states that the London Borough of Waltham Forest will deal with any adult protection issues. As the home is located in the London Borough of Hackney, the local borough (in this case the London Borough of Hackney) would be responsible to co-ordinating any adult protection meetings etc. This must be accurately reflected in the home’s statement of purpose. There was an admission policy in place, which clearly describes the referral process and outlines the home’s admission system, as well as trial visits and introductory period for service users. Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 10 There have been no new admissions to the home since the last inspection and as a result standard relating to the home’s admission systems was not fully assessed on this occasion. It will be retested once a new admission has taken place. The last inspection report stated that there was a new contract/statement of terms and conditions in place, however there was no evidence of it being issued to the residents. In response action plan submitted to the Commission following previous inspection, the registered manager stated that difficulties have been encountered with residents who were unable to sign on their own behalf and that contact with families has been made for the standard to be completed. At the time of this inspection individual contracts remained unsigned. The requirement has therefore been repeated and must be met without any further delay. Further failure to comply with the regulation will result in the Commission considering an enforcement action against the registered manager/proprietor. Linton Lodge DS0000010275.V354077.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, 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there was some evidence that improvements have been made to service users’ care plans, further work is required to ensure that care plans are reviewed and evaluated at least six monthly and updated to reflect changing needs. Improvements are also required to the home’s risk management systems. EVIDENCE: As part of this visit, the inspector reviewed care plans of five service users accommodated in the home. On the first day of this inspection, a member of staff could not locate care plan of one of the service users. The inspector was informed by the registered manager on the second day of inspection that the service user’s care plan was not previously available in the home as it was being typed. This document was presented to the inspector on the second day of this inspection. There appeared to be some improvement in the home’s care planning systems, although further work is required to ensure that care plans are reviewed and Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 12 evaluated at least on six monthly and updated to reflect any changing needs of each service user, as at the time of this visit not all care plans have been reviewed in the last 6 months. Service user’s placements appeared to be reviewed by their placing authority on an annual basis, following which care plans were forwarded to the home. It was noted that not all action points listed in the local authority care plans have been included in the home’s individual care plans and they therefore required updating. Following the review of documentation, as well as discussion with staff and the service users, the inspector was satisfied that people who used the service were involved in the day-to-day running of the home, participation of activities of daily living and involvement in choice of daily activities. They were also encouraged to maintain their personal space, preparation of drinks and doing their laundry depending on their abilities. Each person living in the home had a weekly plan and staff supported them to complete daily living tasks around the home. Appropriate risk assessments were in place, however they were not being regularly reviewed. Although dates when individual risk assessments were due for review were noted, there was no evidence that these have been undertaken. In order to maintain appropriate risk management systems in the home, the registered manager must ensure that risk assessments are reviewed on a regular basis. Confidentiality was being maintained at the time of this inspection. Files were kept locked away when not in use and staff shared information with the inspector on a need-to-know basis. Linton Lodge DS0000010275.V354077.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, 15, 16, 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ rights and choices were respected and they had opportunities for personal development. Those who live in the home are encouraged and supported to lead active lifestyles within the local community and develop and maintain friendships and family links. Service users enjoyed food in the home, however improvements are required to the storage of food. EVIDENCE: During a discussion with one of the people living in the home, the service user confirmed that staff encouraged him to be a part of a local community. This was also evidenced in daily logs and service users’ individual care plans. The proprietor and staff working in the home during this inspection confirmed that service users go out in the local community, visit their friends and relatives and some service users attend local day centres. Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 14 Staff encourage service users to be involved in many activities and organisations (such as day centres) outside the home. Those who live in the home assist with tasks around the home in line with their individual abilities. Most of the service users go out during the day; some people who use the service need to be supported by staff, whilst others have been assessed as capable to access local community independently. The home maintains a record of all activities and outings attended by those who use the service. Some of the activities attended by service users were: going to church, ice-skating, walks, trip to Southend-on-Sea, trip to Romford. Service users are offered an annual holiday, which is organised by the registered manager. This year residents went to CenterParcs near Colchester. One of the service users also went to Spain. People who use the service were observed being able to move around the home without any restrictions. Daily records maintained in respect of each service user indicated that they were able to get up and go to bed as and when they wished to. Documentation seen evidenced that service users were encouraged and supported to maintain family links and friendships. Relatives are encouraged visit service users at Linton Lodge. The home offers three meals daily when service users are present in the home, with additional drinks and snacks. Record of food offered to service users was maintained at the time of this inspection. As part of this visit, the inspector checked kitchen and food storage facilities. It was noted that there was a salad cream kept in the fridge, which was not labelled. One of the members of staff working in the home on the day of this visit informed the inspector that the salad cream was for staff use. As the fridge can be accessed by some of the service users living in the home, the inspector felt that the above explanation was unsatisfactory. In addition, the fridge contained some tinned tomatoes stored in a plastic take-away container, which was labelled “Opened on 29/09”. This meant that they have been stored in the fridge for approximately 11 days. As there has been an ongoing concern in relation to the storage of food, the Commission will be issuing an enforcement notice against the provider. Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 15 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. No progress has been made to ensure that there are safe medication systems in place. As a result, the current practice and poor recording puts service users at risk. EVIDENCE: People who use the service require a range of support with personal care from verbal prompting to supervision and assistance with regard to bathing and assistance with toileting. Service users are fairly independent and are able to make decisions regarding when they choose to get up and retire to bed and what activities they wish to undertake. Staff support some of the service user with daily routines on a daily basis. Documents maintained in the home indicated that appropriate referrals were made to members of multidisciplinary team when required. Service user’s files contained documented medical appointments to General Practitioners, Dentists, Psychiatrists and other relevant medical professionals. Each person had a Health Action Plan in place. These were generally detailed and contained guidance for staff in relation to service user’s health issues. It Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 16 was recommended at the last inspection visit that Health Actions Plans be updated with actual dates of annual checks completed/due. At the time of this inspection visit, this recommendation was not met. It has therefore been repeated. It was also noted that one of the care plans supplied by one of the service user’s placing authority requested that his weight should be monitored and recorded. At the time of this inspection, this was not being carried out. In order to monitor service users weight, the registered manager must ensure that where it has been identified, a record of weigh in respect of individual service users is maintained, in accordance with their individual care plans. The home’s medication systems remain to be of concern to the Commission. During an audit undertaken during this inspection visit, it was identified that staff did not always sign for medication, which has been administered to service users. In case of one of the service userS, a number of tablets in stock did not correspond with his Medication Administration Record (MAR sheet). Another service user’s “as required” (PRN) medication who was prescribed was also incorrect, as 12 tablets were missing and we unaccounted for. Moreover no MAR sheet has been in place for this medication since May 2007. Another service user’s medication box contained 1 tablet extra (with 20 tablets signed for as administered out of 28 tablet box, whilst 9 tablets were still remaining in the box). Medication stocks were being kept either in the small medication cabinet located in the staff room or in one draw of the filing cabinet. During a medication audit, the inspector came across several packs of old medication, which had been prescribed to a service user who was no longer living in the home and this medication had expired between November 2002 and December 2004. The registered manager must ensure that any unused medication is returned to the pharmacist for safe disposal, in order to maintain appropriate medication systems in the home. The inspector noted that it was a common practice for staff to use correction fluid on MAR sheets. As MAR sheet are classified as official documents, this practice is unacceptable and must be stopped. The registered manager must ensure that correction fluid is not used on any official documents (including Medication Administration Records). Due to ongoing failure to ensure that the home’s medication systems are appropriately manager, the Commission will be issuing an enforcement notice against the provider to ensure compliance. Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. 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. Complaints appeared to be appropriately dealt with, however the home’s complaints policy required review. Some improvements were required in relation to the service user’s financial matters. EVIDENCE: The home had a complaints policy in place. The current policy states that “all complaints will be treated with complete confidentiality”. As this may not always be possible (due to adult protection issues etc), the home’s complaints policy must be amended. There have been 4 complaints made to the home since the last inspection and they appeared to have been resolved. As part of this visit, the inspector checked financial records kept on behalf of the service users. As some of those who use the service are unable to make any decisions in relation to their financial affairs, all purchases on their behalf are made by staff supporting them. The home kept a small amount of money for each person who used the service. Whilst checking the receipts, the inspector was concerned to note that some staff have used the loyalty cards when making purchases on behalf of the service users, even though those loyalty cards were not registered in the name’s of the service users. This practice in unacceptable and must be stopped. The inspector has raised his concerns in relation to this matter to the registered manager, as using loyalty cards other than those that belong to the service users should be considered as theft and disciplinary procedures should be invoked. The registered Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 18 manager must ensure no loyalty cards are used when making purchases on behalf of a service user, unless the cards are in the service user’s name, in order to protect the service user from financial abuse. At the time of this visit, receipt kept in respect of each service user were not kept in order and not numbered. In order to allow easier auditing of expenditures made of behalf of service users, it is recommended that all receipts be kept in order and numbered. Since the last inspection, the registered manager has ensured that there is an Adult Protection policy in place, as previously required. The policy/procedure included information what actions must be taken by the home and ways of reporting adult protection issues to relevant authorities. There have been no incidents since the last inspection. Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 19 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, 26, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a safe, clean and homely environment. EVIDENCE: Linton Lodge is situated in a quiet residential area and is in keeping with the surrounding houses and neighbourhood. It offers easy access to local amenities and transport links. As part of this visit, the inspector conducted a tour of the premises, during which he spoke to some of the service users living in the home. 3 service users showed their bedrooms to the inspector. 2 of the service users stated that they were happy with their bedrooms and communal areas of the home. Another service user was unable to communicate verbally, however it was the inspector’s opinion that his bedroom was attractively decorated and appropriately personalised to reflect the service user’s culture, background and hobbies. Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 20 The inspector was satisfied that the premises are suitable for the stated purpose and that it is accessible to the current service user group. There is no lift in the home, however there is a chair lift fitted to the staircase, which is not operational. Staff working in the home on the day of this inspection confirmed that this would be in use, should any of the service users required it. The office is situated on the first floor. There is no separate visitors room available. The home has a small garden with a patio area. On street parking in the area is unrestricted. The premises were comfortable, bright and airy. There was sufficient light, heat and ventilation at the time of this inspection. Furnishings and fittings were of adequate standard. Care staff share all cleaning jobs within the home and service users are supported by staff to tidy up and clean their own rooms if required. All communal areas and bedrooms viewed during this inspection were found to be clean and hygienic. There is a small laundry facility in the basement. Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 21 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. Limited progress has been made to ensure that staff have received all mandatory training. Urgent action is required by the provider to ensure that staff have been appropriately vetted to care for vulnerable adults. Staff supervision sessions must be introduced. EVIDENCE: During this inspection visit, the inspector checked duty rosters to ascertain how often the registered manager visited the home. The registered manager stated that she did not always record on the duty roster times when she was working in the home. This required improvement. The registered manager must ensure that a copy of the duty roster of persons working at the care home is maintained, and a record of whether the roster actually worked, in order to demonstrate staff appropriate staffing levels and management support is in place. The home appears to have at least 2 staff of duty during the day when all service users are in the home. There is one person doing a sleep-in duty at night. Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 22 2 of the service users who spoke with the inspector during this inspection visit stated that they were satisfied with the care provided. Members of staff who were present on both days of this inspection were aware of their roles and what was expected of them. The registered manager has failed to provide information to the Commission in relation to staff having obtained or working towards their NVQs (National Vocational Qualifications). As the registered manager was not present during the last unannounced inspection and on the first day of this inspection visit, the inspector decided to come back to the home when the registered manager was working, in order to gain access to staff supervision, recruitment and staff training records. The inspector checked staff personnel files of 5 members of staff. Records in relation to care staff employed in the home continue to be unsatisfactory. Some of the shortcomings were: - Lack of evidence to work in the United Kingdom (such as copy of a British Passport or other passport with a valid visa/work permit), - One person had a photocopy of only first page of their Criminal Records Bureau check, - One member of staff has been allowed by the registered manager to work with Criminal Records Bureau disclosure, which was carried out by another employer (CRB disclosures are not portable) and which was out of date and did not include check against the Protection of Vulnerable Adults List, - Another member of staff had a Standard CRB disclosure, as opposed to the Enhanced one, - The registered manager failed to obtain a reference from the previous employer for one member of staff, even though the job the person was working was relevant to their current position (working with vulnerable children), -Some checks were more than 3 years old and did not include POVA checks and should therefore be repeated. Due to ongoing failure to comply with the regulation relating to staff recruitment, the Commission has decided to issue an enforcement action to the provider in relation to this matter. As in case of one of member of staff, there was no evidence of their entitlement to work in the United Kingdom; the requirement that the registered manager must ensure that staff work in line with any visa restrictions in place has been repeated. Limited progress has been made by the provider to ensure that staff have received mandatory training. Some staff have been allowed to work in the home without any fire safety training and other mandatory training. The Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 23 requirement has therefore been repeated and must be met without any further delay. No progress has been made with staff supervision. The registered manager stated that she “doesn’t really write up minutes from supervisions”. The Commission is concerned that staff have not been receiving formal supervision since at least 2004. As a result, an enforcement notice will be issued to the provider in relation to this matter. Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 24 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, 42, 43. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Limited progress has been made to ensure that previous requirements and recommendations have been met. Failure to comply with the Regulations adversely affects the quality of care offered to the service users. Most of the health and safety checks were in place. EVIDENCE: As stated throughout the body of this report, the inspector is concerned with a high number of unmet requirements and recommendations and limited progress made to ensure compliance with the Regulations. As previously mentioned, the registered manger has also failed to supply the Commission with a completed Annual Quality Assurance Assessment (AQAA), despite several extensions granted by the Commission. As a result a separate requirement has been made to ensure that the registered manager returns a completed AQAA document. Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 25 Due to duty rosters not kept up-to-date, the inspector was unable to fully establish the manager’s input in the home. As the registered manager is also the proprietor, she is not required to undertake “visits by registered provider”. It is recommended however that the registered manager formalise feedback from professionals, service users and families with regard to their satisfaction by implementing a system to record feedback with regard to the service provision. The majority of health and safety checks were in place, however as previously mentioned storage of food in the home continues to be an issue. At the time of this visit, the registered manager failed to have a business plan in place, even though in her letter dated 31/08/06, which was the response/action plan to the last inspection report she stated that “this has now been addressed and are available for inspection”. The Commission will be issuing an enforcement notice in relation to this matter. The home was appropriately insured for its purpose. Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 26 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 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 1 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 1 1 2 X X 2 1 Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 27 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 YA34 Regulation 19 Requirement The registered manager must ensure that staff work in line with any visa restrictions in place. (Previous timescale of 31/07/06 was not met.) The registered manager must ensure that all staff completed mandatory training. (Previous timescale of 31/05/06 was not met.) The registered manager must ensure that all service users have signed contracts in place. (Previous timescales of 30/04/06 and 31/08/06 were not met.) The registered manager must ensure that individual care plans are reviewed and evaluated at least six monthly and updated to reflect changing needs. (Previous timescale of 31/08/06 was not met.) In order to maintain appropriate risk management systems in the home, the registered manager must ensure that risk assessments are reviewed on a regular basis. The home’s statement of purpose must be updated to DS0000010275.V354077.R01.S.doc Timescale for action 15/12/07 2. YA35 18(1) 01/02/08 3. YA5 17 01/01/08 4. YA6 15(2) 01/01/08 5. YA9 13(4)(c) 01/01/08 6. YA1 4 01/01/08 Linton Lodge Version 5.2 Page 28 7. YA19 12(1) 8. YA20 13(2) 9. YA22 22 10. YA23 13(6) 11. YA33 17(2) Schedule 4.7 12. YA37 24(2) include correct details of the local authority in relation to handling any adult protection issues. In order to monitor service users weight, the registered manager must ensure that where it has been identified, a record of weigh in respect of individual service users is maintained in accordance with their individual care plans. The registered manager must ensure that any unused medication is returned to the pharmacist for safe disposal, in order to maintain appropriate medication systems in the home. The registered manager must ensure that the home’s complaints policy is reviewed and the statement that “all complaints will be treated with complete confidentiality” is removed, in order not to mislead a complainant. The registered manager must ensure no loyalty cards are used when making purchases on behalf of a service user, unless the cards are in the service user’s name, in order to protect the service user from financial abuse. The registered manager must ensure that a copy of the duty roster of persons working at the care home is maintained, and a record of whether the roster actually worked, in order to demonstrate staff appropriate staffing levels and management support is in place. The registered manager must ensure that a completed Annual Quality Assurance Assessment is returned to the Commission. 01/12/07 01/12/07 01/01/08 01/12/07 15/12/07 15/12/07 Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 29 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. 2. 3. Refer to Standard YA19 YA23 YA39 Good Practice Recommendations It is recommended that Health Action plans be updated with the actual dates of annual checks completed/due. (This is a repeated recommendation). In order to allow easier auditing of expenditures made of behalf of service users, it is recommended that all receipts be kept in order and numbered. It is recommended that the registered manager formalise feedback from professionals, service users and families with regard to their satisfaction by implementing a system to record feedback with regard to the service provision. Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 Linton Lodge DS0000010275.V354077.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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