Inspection on 31/08/07 for Linwood

This inspection was carried out on 31st August 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 but made no statutory requirements on the home.

Other inspections for this house

Linwood 06/07/09

Linwood 10/02/09

Linwood 29/08/08

Linwood 04/05/06

Linwood 19/04/05

Linwood 01/12/04

Linwood 19/07/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Linwood 9 Mercer Close Thames Ditton Surrey KT7 0BS Lead Inspector Pat Collins Unannounced Inspection 31st August 2007 10:20 X10015.doc Version 1.40 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 Linwood DS0000059210.V342338.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 Older People. 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. Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Linwood Address 9 Mercer Close Thames Ditton Surrey KT7 0BS 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) 0208 335 6800 0208 339 3485 lorraine.hillsavery@anchor.org.uk keri.sherwood@anchor.org.uk Anchor Trust Lorraine Hills-Avery Care Home 66 Category(ies) of Dementia - over 65 years of age (27), Old age, registration, with number not falling within any other category (30), of places Physical disability over 65 years of age (9) Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Of the service users to be accommodated in the home up to TWENTY SEVEN may fall within the category Dementia DE (E) and up to NINE may fall within the category Physical disability PD (E). Temporary respite care may be provided for one named service user under the age of 65 years. 4th May 2006 2. Date of last inspection Brief Description of the Service: Linwood is a purpose built care home that has been operating since April 2004. Service provision is for personal care for up to sixty-six older people, some of whom may have moderate dementia or mental health needs and/or physical and sensory disabilities. The home is owned and managed by Anchor Homes who are the registered providers. Linwood is located in a residential area within walking distance of Thames Ditton village where there are a small number of shops and other community amenities. A GP practice is nearby. There are car-parking facilities to the front of the building and further parking spaces and an enclosed garden to the rear. The accommodation is divided into six named living units over three floors. Upper floors are accessible by one passenger lift and stairs. The home is wheelchair accessible throughout, however wheelchair users are restricted to two per unit other than on the ground floor, for health and safety reasons. There are eighteen single bedrooms on the ground floor, all with fully functioning en-suite shower rooms. There are forty-eight single bedrooms over the first and second floors. These are all fitted with en-suite shower rooms for which a single charge applies for showers to be made functional. Communal facilities are arranged on each floor comprising of small kitchens, dining rooms, lounges, toilets and assisted bathing facilities. There is also a hairdressing suite and a large reception area on the ground floor. Fee charges range from £454 to £747 per week. Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit forms part of the key inspection process. Judgements about the home’s management and services are based on a cumulative assessment and knowledge of service provision since the last key inspection in May 2006. Information supplied to the Commission for Social Care Inspection (CSCI) by the home manager has been taken into account. Ms Pat Collins, Regulation Inspector, undertook the inspection visit. This began at 10:20 hrs and concluded the same day at 21.15 hrs. The home manager was present throughout. We have looked at how well the home is meeting the national minumum standards set by the Government. Judgements about standard of service provision are detailed in this report. A partial tour of the premises took place and records were sampled. The views of people living in the home were sought through consultation at the time of the visit and through a questionnaire survey. Ten questionnaires were received from people using the home’s services, eleven from their relatives or representatives and one from a professional in regular contact with the home. Communication with some people using services was limited due to difficulties with communication. The term ‘residents’ is used hereafter in this report when referring to people using the home’s services. This is in accordance with the expressed preference of residents consulted in this matter during the visit. The inspector would like to thank all who contributed to the inspection process and in particular all residents and staff for their time, hospitality and assistance throughout the inspection visit. What the service does well: The organisation has worked hard to produce information that is meaningful to prospective residents and their relatives; this enables informed choice regarding the home’s suitability to meet needs and aspirations. The statement of purpose, which tells people who the home is for, and service users guide, that tells people how it works, are produced in an information pack. This pack has been professionally produced and is available in other languages. It comes with a large text /audio DVD disc. The home’s admission policy is underpinned by equal opportunity principles. New residents have a comprehensive needs assessment, usually before admission. The assessment focuses on achieving positive outcomes for residents, ensuring the home’s facilities and services can meet needs, including ethnic and diversity needs. Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 6 Residents were appropriately dressed in relation to age and culture at the time of the inspection visit and mostly well groomed. They receive support and encouragement to enable independence and autonomy within individual capabilities. They are able to choose the things they enjoy doing within the home. Conversations with a number of residents and survey feedback from others confirmed generally residents were satisfied with their care, the cleanliness of the home and how the home operates. Comments from residents relatives/representatives include “ The carers are always polite and helpful”, “overall I think the home provides a good service, however they should realise they are dealing with relatives of other people”, “ The home is organised, caring and clean and has a pleasant atmosphere” On the day of the visit it was good to observe a spontaneous sing-along initiated by a care assistant and enjoyed by a group of residents on one unit. Some residents were seen in their rooms reading or watching television. A lot of laughter and good- humoured exchanges between staff and residents was observed on another unit over the evening meal. The activities coordinator tries hard to provide a stimulating activities programme within the time available. The physical environment is modern and domestic in character, each unit having its own name. There is a choice of being alone or in company and residents’ rights to privacy are respected. The menus are varied and residents have a choice of food. The main kitchen was organised on the day of the inspection visit and hygiene and cleaning standards in this area were excellent. Catering staff listen to residents’ feedback about food and try to accommodate suggestions for change or improvement to meals and menus. The practice of renewing Criminal Record Bureau Disclosures for staff every three years is commended. Most staff were warm and friendly in their approach and interaction with residents. Personal care was delivered in private. Staff on duty in one of the units demonstrated awareness of the special communication needs of a resident. They were skilled in using appropriate communication techniques affording choice for this individual in her daily life. What has improved since the last inspection? The manager is now registered by the CSCI. A new assessment and care planning system is being implemented which should enhance assessment and care planning practice once fully operational. The approach to assessment and care planning using the new system is inclusive, involving residents within individual levels of capacity and relatives/ representatives, as appropriate. The new care plans are clear and easily navigated. Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 7 As part of this system a new alert mechanism has been put in place. This is aimed to inform team leaders and management of significant information and concerns about residents’ health and welfare. In principle this system should ensure an appropriate response; also for a care plan to be produced specific to this problem and follow up by team leaders. It was good to note a programme of training for care staff intended to improve arrangements for meeting residents’ social care needs. Twelve care staff had received training in therapeutic activities for older people. Additionally, fourteen staff had received training in the management of challenging behaviours since the last inspection. A positive new development is the creation of a laundry assistant post. A laundry assistant has been recently appointed and undergoing recruitment vetting procedures before joining the team. What they could do better: Communication with residents’ relatives and representatives is not meeting their expectations and requires review. There is need to agree responsibility for notification of significant events to the advocate of a resident with care management. Also to check the home’s records including care documents to ensure contacts details for residents’ relatives/representatives are up to date. Substantial shortfalls were identified in some care plans sampled and related record-keeping practices. Risk assessments need to be further developed and include also assessment of risk for residents who choose to self medicate. Details of where improvement is necessary is in the main body of the report. The frequency of reviewing care plans needs to be at least monthly or in accordance with the organisation’s policy. A more robust system of reviewing and monitoring care documents and care practice is necessary. The alert system was not operated effectively in the case of one resident to ensure needs were fully met. Supervision of residents on the ground floor was at times inadequate during the inspection visit to meet the demands of care and ensure residents’ safety and wellbeing. Feedback from some visitors to the home and direct observations during the inspection visit supports the need for this requirement to be made. Further information about this is also in the report. Practice for personal care should be reviewed to be confident that all residents are offered opportunity to have baths or shower in accordance with their care plans and individual preference. A mechanism needs to be in place to inform staff which residents have and have not had opportunity for baths and showers. The feedback from staff that this is managed so that all are offered a bath and shower daily cannot be verified; neither is it realistic if there were to be a high uptake of this opportunity. There is no system currently for management to monitor this area of practice and this requires review. Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 8 Record keeping relating to residents is very fragmented and suggested this also be reviewed. Four relatives were highly critical of the standard of cleanliness in bedrooms. The inspection visit highlighted the need to review the adequacy of storage facilities for toiletries and incontinence pads in en suite rooms. There is need to review the adequacy of arrangement for stimulation and meeting social care needs. Provision must be suitable for all residents for whom the home is intended, in accordance with the homes stated purpose. Care planning needs to be more holistic. Some residents stated they would like the activities programme to be expanded and more opportunity for outings, which was also the view of some relatives. One resident said he was bored. A medical practitioner in regular contact with the home expressed the view that residents are bored and depressed. It is acknowledged the manager is aware that this area needs to be developed. Formal arrangements are needed to ensure staff taking up post without a Criminal Record Bureau Disclosure are directly supervised when in contact with residents in bedrooms. Compliments, concerns and complaints leaflets need to be accessible to the public at all times. The manager needs to ensure systems are in place to keep her informed of all concerns and complaints. It could be these originate from review meetings and the system needs to capture and record these issues. The home’s management needs to ensure follow up actions agreed at review meetings and ensure these are implemented and sustained. 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. Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 1, 3, 6. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective residents and/or their representatives are supplied with the information necessary to enable an informed choice about the home’s suitability to meet individual needs and aspirations. Prospective residents are fully assessed prior to admission to be assured their needs can be met. Service provision does not include intermediate care. EVIDENCE: The statement of purpose, which tells people who the home is for, and service users guide, that tells people how it works, are produced in an information pack. This is sent to all people making enquiries about placements. This pack has been professionally produced, providing details about the home and a guide to other Anchor services. It is stated to be available in other languages and comes with a large text /audio DVD disc. This information is prominently displayed in the reception area together with a copy of the home’s latest CSCI inspection report. The manager was noted to be updating a supplementary information document about the home, which will be included in information packs. Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 11 The admission procedure is underpinned by an equal opportunities policy. Assessments for admission are undertaken by the manager or a deputy manager and may take place in prospective residents’ own homes, in hospital or over a one - day period at Linwood. A team leader or care assistant was stated to be involved in assessment visits. There has been a change to assessment/care planning documentation since the last inspection. New assessment tools ensure comprehensive needs assessments are carried out prior to admission. Assessment information forms the basis of the initial care plan on admission. Areas of discussion with the manager included the view expressed to the CSCI by a general practitioner who visits the home that individual residents with dementia require nursing home or hospital placements. The admission criterion for people with dementia was clarified. The home’s statement of purpose is clear that the home provides personal care and accommodation for older people of mixed gender who may have physical disabilities, moderate dementia and some mental health needs. Single assessment summaries are obtained for all prospective residents’ placed by care management in advance of admission. These assessments make clear that these individuals do not require full time nursing or specialist dementia care. An emergency admission will be accepted following sufficient information provided by the purchaser to enable the home to decide whether needs of that individual can be met. The manager was clear that placements would not be agreed for prospective residents who have a known history of extreme antisocial or aggressive behaviour. There have been times when this information has not been disclosed however during the assessment process, though stated this was not common. Sometimes the loss of familiar surroundings for new residents’ in itself can trigger this type of behaviour and staff endeavour to manage needs where possible. Senior staff are aware of how to access psychiatric specialist services for older people if needed. Records sampled and staff consulted confirmed care management has been requested to review placements if the home can no longer meet individual needs. Included in this discussion was review of assessment methods and events leading up to a former resident’s compulsory admission to hospital for psychiatric assessment. The manager confirmed early request made by the home for psychiatric assessment for this individual. It was stated that efforts to obtain an assessment however had been unsuccessful until such time that the situation had escalated and was at crisis point. The manager confirmed pre-admission assessments for this person revealed no previous mental health problems. The home’s philosophy of wherever possible trying to provide a home for life was discussed. This is on the basis that medical and nursing needs can be sustained by primary healthcare staff which including nursing input from district nurses. The manager was clear that care staff have training in care of Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 12 the dying. When residents’ develop a terminal illness effort is made to care for them in the home; it was stated that staff avoid moving these individuals to a nursing home or hospital unless it is in their best interest. Service provision does not include intermediate care. Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Needs are assessed and care plans produced. Shortfalls in care plans and care records were observed and a more robust system of reviewing and monitoring care documentation is necessary. Whilst the management of medication was generally satisfactory attention is necessary to risk assessments for residents that self-medicate. The principles of respect, dignity and privacy are put into practice. Supervision of residents on the ground floor was at times inadequate during the inspection visit. EVIDENCE: There had been no progress in designating two units on the second floor as dementia care environments. This was on the basis that families consulted had not wished to unsettle residents who would have had to move out of their rooms. The inspector observed care practice in communal areas on all three floors. Most staff were warm and friendly in their approach and interaction with residents. Personal care was delivered in private and staff on duty in one of Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 14 the units demonstrated awareness of the special communication needs of a resident. They were skilled in using appropriate communication techniques affording choice for this resident in her daily life. Residents were appropriately dressed in relation to age and culture and were mostly well groomed. Observations confirmed they were supported and encouraged to retain independence and autonomy within individual capabilities. It was good to observe staff had accommodated the wishes of a resident who preferred to eat his meals on his own. As an alternative to serving his food in his bedroom staff had thoughtfully set a nicely presented dining table in a small lounge. The same resident had a key to his bedroom door, enabling security of personal possessions when out of his room. He informed the inspector these two factors gave him a sense of being in control of his environment. He emphasised their importance to his wellbeing. He stated he enjoyed walking to the local pub for a drink from time to time with a visitor. Conversations with other residents confirmed they were generally satisfied with the home. Eight residents who responded to the CSCI survey considered the care and support received always met their needs and four said usually. In response to the question whether staff listen to them, nine residents said always, one stated usually, one said sometimes and one stated never. Staffing levels on the ground floor reduced to one care assistant whilst the other went on a lunch break. The lay out of the ground floor is complex with the eighteen rooms arranged across two wings separated by the reception foyer. At that time a group of residents, including five wheelchair users, were sat in a lounge. Others were in their rooms in both wings. The care assistant spent most of this time in the proximity of the lounge though there were occasions when there was no visible staff presence on either wing. This was whilst the care assistant assisted residents to and from the toilet. Though the team leader based at the reception desk was stated to be available to be called on if needed, most of this time she was busy with administrative duties and on the phone. A resident assessed to be at risk of falling was in his bedroom in the wing furthest from the lounge. From the corridor he was seen to be asleep on top of his bed and his zimmer frame at the far side of the room. When asked if this resident would be safe to walk on his own to reach the zimmer frame if he awoke the care assistant acknowledged he would be at risk of falling without assistance. He did not have capacity to use the call bell to request assistance. A visitor gave feedback that on occasions when visiting the home, particularly at weekends, staff were very busy and residents were calling out for assistance to go to the toilet for a long time before receiving attention. He also stated that on occasions, the person he was visiting had been incontinent and sat in wet clothing. This visitor spoke highly of staff but felt the number of staff Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 15 could not always meet the demands of care. It was stated that this concern had been reported to team leaders on more than one occasion. The manager had not received any feedback from staff in this matter and agreed to follow up. Following the inspection similar feedback was received from another relative thought not known whether this was reported to senior staff. Residents were stated to have key workers. At the time of sampling care records on two occasions the named key worker on these records had left and key worker not replaced. A new care planning system is being introduced and work in progress for transferring information from old care records to the new documentation. Additional assessment tools are included in the system and the new care plan format is more detailed. The system promotes inclusive practice in care planning, involving residents who are able or wish to be involved also relatives. This system has been developed corporately and is being implemented across all the organisation’s care homes. The transfer to the new care planning system is a major, time intensive task and each unit noted to be at differing stages of completion. The manager had the old care files with care plans, care notes and assessment in her office of those residents who were now using the new care planning system and preparing these for archiving. Care records were sampled on all floors and their storage ensured residents’ confidentiality is protected. The inspector raised concerns with management regarding the absence of care notes across the whole home. This was discussed separately with the manager and a deputy manager and the information received confirmed a lack of clarity about record keeping practices in respect of the new care planning system. The manager agreed to consult Anchor’s national care team for advice. It was not evident how staff will be able to monitor residents’ care, review their needs and care plans without some form of record keeping practice affording an audit trail of care. Currently there is no way for staff to know if care plans are being followed, are working or need changing. The manager’s understanding of the new alert record and system is that this is now the only care record needed. These alert forms however relate only to care plans generated for specific problems, for example in the event of illness, falls, significant change in a residents condition; these ensures team leaders and managers are aware and appropriate response and follow up. The need to reinstate the practice of monthly reviews of care plans was also discussed. The manager thought team leaders were doing this however this was not evidenced. Concerns about aspects of a residents care and hygiene and failure to maintain care records for this individual was discussed with management. Feedback has since been received from some relatives also raising concern about bathing practices. An alert record was in place for this individual and feedback from a care assistant signified recent health related problems and medical input. The alert record included an entry made the day prior to being seen by a medical practitioner. This referred to the person having had a fall, bumping her head. No other information was documented to demonstrate action taken to ensure Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 16 the welfare of this resident and of any monitoring practices to exclude any possibility of serious head injury. Doctors’ visits relating to physical illnesses, diagnosis and medication prescribed was the extent of the record keeping for this resident. Care plans had been produced specific to this individual’s health conditions, one of which included the need to encourage plenty of fluid. No records were kept to ensure this care plan was followed. This resident had an incomplete baseline assessment and it is recognised work was still in progress for transfer of information to the new care documentation. It was concerning however to note an undated dietary/nutritional assessment from which a care plan had been produced in response to swallowing and chewing difficulties. Given this person’s existing problem with eating, recent history of ill health and need for increased fluid intake also the additional factor that staff do not always work on the same unit which could affect continuity of information flow, the absence of record keeping for this resident’s care was of concern. Discussion with a care assistant confirmed this individual had been resistive to personal care and aggressive, likely associated with the physical illness. There was no record made of this or a care plan produced for managing this behaviour. It is recommended that the current fragmented record keeping practices relating to information about residents be reviewed. It is suggested that all care documents be stored on residents’ files. This includes pre-and post admission assessments, care plans including social care records and review notes. It is also recommended that the care progression and evaluation forms, that are part of the new care planning system be used to provide an audit trail of care. It was evident from observations that a robust monitoring system needs to be implemented to ensure care records and care plans are brought up to standard. Feedback was received from a relative that the information being laboriously copied over from the old care documents to new included errors and out of date telephone numbers. It is essential that the change over to the new system be approached in a way that ensures needs are reassessed and information updated as part of this process. Gaps in record- keeping on files sampled included weight monitoring for some individuals. It was noted that the home did not have equipment for weighing individuals unable to weight bear and possibly this may account for some gaps. The inspector was informed that suitable weighing scales were now on order. On some files but not all, staff continued to use a chart for recording baths. Observing large gaps in these records of two residents accommodated on the ground floor unit it was not possible to know if residents were having baths and this information not recorded; or being offered opportunity for a bath in accordance with their care plans and declined the same. In discussion with two care staff separately who were working on the ground floor unit, they gave conflicting information when asked when residents had their baths. Noting information from one of these care assistants that care staff work across all Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 17 units it was not clear how staff were able to know who had been offered a bath to ensure all residents had this opportunity without some form of record being kept. The home has a number of residents who have communication and memory problems and may not be able to recall when they last had a bath for staff to manage this effectively. A relative reported to the CSCI that this person had been told by care staff on several occasions that baths are only offered if a resident requests them. It was stated that management denied this. Another relative referred to an agreement for her mother to have three baths a week however the frequency was once a week. On the care files sampled the inspector did not see record of residents’ being consulted and having opportunity to express preference of the gender of carers carrying out intimate personal care. Whilst recognised that the number of male care staff is small and preference for a male carer may not be always practical it is suggested this discussion takes place as a matter of good practice. Also to ensure diversity needs are identified. Arrangements were being made for review meetings to take place. According to the home’s policy these should be every six months however there had been slippage in the review schedule. Feedback from three relatives was received that referred to review actions and agreement not always carried through. The manager confirmed some care management reviews were also overdue which was owing to shortages of care managers. Two care management reviews had recently taken place for new residents at the end of their trial placement period. End of life care plans are included in the new care planning system. The inspector was informed that no residents were receiving palliative or terminal care at the time of the visit. It was stated senior staff are aware of how to access local palliative care teams and the home receives excellent support from the district nursing service. The manager advised that she and a number of staff had attended a three-day end of life training course. She acknowledged some staff experience difficulty in discussing end of life plans with residents and relatives. The training was stated to have been helpful by raising awareness of how to approach the subject sensitively and appropriately. It was suggested the manager liaise with the local Primary Care Team to clarify the local End of Life Care Strategy and preferred tools/models, which the home might adopt. An end of life plan was sampled and found to be incomplete. It was evident from the care documentation for the resident concerned that physical dependency had increased. The manager’s attention was drawn to the omission to document details of the advocacy scheme and nominated advocate on the care records of this resident. The advocacy scheme has legal responsibility for managing this person’s financial interests. It was suggested that the manager discuss with the care manager whether the advocate should be consulted about making a Will. It was noted this person had recently been Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 18 in hospital and the advocate not notified by the home though the care manager was. It was apparent the home must agree with care management responsibility for notifying this person’s advocate of significant events. The end of life plan for this resident needs further attention. It includes the name of a friend this person would like informed in the event of his death however no information recorded to enable contact to be made. Staff carry out pressure sore risk assessments. This enables prompt referral of residents’ identified at risk to district nurses for further assessment. Also to plan effective pressure sore prevention strategies including loan of suitable pressure relieving equipment. Monthly audits are carried out of pressure sores and this information supplied to the organisation’s national care team. The manager was advised to ensure the home’s care plans also cover pressure sore prevention management, cross referencing information in plans produced by district nurses. Residents are all registered with a GP. They may retain their own GP on admission provided the practice is within the locality or they may register with the GP practice nearby. There is access to all health care services, which includes visits by opticians, chiropodist, and dentist in accordance with needs. Medication was observed to be securely stored and medication records sampled contained staff signatures signifying administration of medication as prescribed. Care staff consulted confirmed they had received medication training. Observation of medication administration confirmed good practice procedures are followed. Care planning documentation includes consent forms for self-administration of medication or for staff to administer. Not all have been signed as yet for various reasons. Requirement was made for risk assessment to be undertaken for a resident who is self-medicating Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 19 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have opportunity to maintain links with friends and family and some residents access the local community. There is a choice of meals and special dietary needs and preferences are met. Observations and record keeping relating to nutrition and fluid intake needs to improve. The home’s atmosphere is friendly and an activities programme is in place. Social care plans need further development. EVIDENCE: There are two part–time activity coordinator posts in the staffing establishment. Only one activity coordinator however has been working in the home since January 2007. She was not on duty at the time of the inspection visit. The other employee had been on long-term sick leave and is now no longer in post. The manager reported that twelve care staff had received training in therapeutic activities for older people since the last inspection. This training was stated to include activities suitable for people with memory loss and limited concentration span. Its purpose was to heighten awareness to the important role care assistants have in ensuring residents social care needs are met. The organisation was stated to be looking into an NVQ Level 2 qualification for activity coordinators. Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 20 The manager recognises that despite the hard work of the activities coordinator that the area of social care at the home needs further development. Observation of care plans sampled confirmed these were not holistic, focusing mostly on physical needs. Baseline assessments and other documentation included limited life history information and details of former interests and hobbies. The necessity for care plans to demonstrate how social needs are being addressed was discussed. They should not just focus on organised leisure activities but incorporate activities of daily living. On the day of the visit it was good to observe a spontaneous sing-along initiated by a care assistant and enjoyed by a group of residents on one unit. Some residents were seen in their rooms reading or watching television. A lot of laughter and good- humoured exchanges between staff and residents was observed on another unit over the evening meal. The activity coordinator was stated to keep social care records. These were not viewed therefore it is not known whether the activity programme meets residents’ interests and hobbies. Some residents stated they would like the activities programme to be expanded and opportunity made for more outings. One resident told the inspector he was bored. Feedback from a professional stated residents in the home were bored and depressed. A number of relatives felt more activities needed to be provided. The activities programme is displayed in the reception area and on units. Activities take place in various communal areas across the home and the programme was understood to be flexible. Two activities sessions are planned Monday to Fridays, one in the morning and one in the afternoons. They include quizzes, skittles, and sherry mornings, sing-a-long & dance sessions, bingo, manicures, dominoes and card games. Some residents go out to day centres. School children were stated to visit the home occasionally, sometimes performing shows for residents. Older school children had joined the activities coordinator, enabling a wider choice of residents’ interests to be met. Social functions are organised to which residents’ relatives and friends are invited. Photographs of these events are displayed in the home. The local library is across from the home and a PAT dogs service started to visit. A regular church service was stated to be provided at the home. A hairdresser provides hairdressing services in the home’s salon and was present during the inspection visit. It was good to note she made time to stop and chat with residents whilst passing through the home. Feedback from a group of residents confirmed how much they looked forward to seeing her. Visitors were made welcome on the day of the visit and they were seen to use kitchenettes on units to make hot drinks. Water and fruit juice dispensers are available for visitors and residents to help themselves to a drink at any time. Guests are stated to be encouraged to stay for a meal. Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 21 The Chef Manager had recently resumed work following a three months period of absence. This had impacted on the basic food hygiene training for care staff. This training was deferred and the manager confirmed her intention to reschedule the same. The deputy chef manager and a kitchen assistant were on duty during the visit. The kitchen was viewed just before lunch and found to be exceptionally clean and tidy and well organised. Both the chef manager and deputy chef have catering qualifications. The Environmental Health Officer report was viewed and a Gold Star Award certificate had been issued by that department. Menus were displayed and the meal served was in accordance with the day’s menu. It was stated that a winter menu was being worked on. Menus were varied and afforded choice of meals. A new development since the last inspection was noted that residents are no longer required to pre-order meals; they can choose what they would like to eat when the meals arrives on units. Dining rooms are available in all units on the first and second floor and one dining room provided for all residents accommodated on the ground floor. Dining tables were nicely presented with tablecloths, napkins and condiments. Food is transported in hot food trolleys and served by care staff. Only one care assistant was seen to wear a tabard when serving food throughout the course of the inspection visit. A care assistant acknowledged aprons were available and it was policy for these to be worn when handling food. The inspector joined a group of residents for lunch in one of the dining rooms. Servings of food were substantial and the meal hot and tasted good. One resident was concerned about fine bones in the fish served in sauce and this feedback given to the deputy chef. Systems are in place for chefs to obtain regular feedback from residents and evidence seen of their positive response to residents’ suggestions. Though none of the residents needed assistance with eating, two of the three residents at the table where the inspector was sat were clearly having some difficulty chewing the batter on the fish they had chosen. This comment is not intended as a criticism of the food. Both residents were scraping the fish out and leaving the batter. One left most of her meal and appeared to tire from the effort of trying to eat. Possibly both may need to be reassessed and encouraged and supported in choosing a soft diet. There was two care staff on duty at lunchtime on the ground floor. A third staff member had gone off duty. Both care staff were very busy having to serve food and attend to residents eating in their rooms. It was not apparent that either took notice of the difficulties residents had with eating or that one resident left nearly all of her meal. In the absence of any form of record keeping for this type of observations and lack of continuity of staffing on the unit, it would appear that weight loss could be the first obvious sign of changes in need and chewing or swallowing problems. Feedback was given to the manager on practice observations during this meal in which a resident request for mashed potatoes instead of chips received no response. As a result this individual only ate part of the meal. Several surveys received from relatives observed that residents fluid intake was not adequately monitored. Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 22 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 16, 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s complaint procedure is prominently displayed. It is important to ensure a supply of compliments, concerns and complaints leaflets are always accessible to residents and visitors for their use. Residents’ rights are respected and policies and procedures in place to safeguard residents from abuse. EVIDENCE: The complaints policy and procedure is displayed in the home. The compliments, concerns and complaints leaflets had not been placed accessible to the public at the outset of the inspection visit. The manager confirmed these had just been received and they were placed by the visitors’ book during the visit. This leaflet invites completion of a short questionnaire by residents and non-residents, enabling expression of views about the home and staff at any time. These can be completed anonymously and sent to the home’s management or external management. Residents and/or their relatives are informed of the complaint procedure. This is included in the information pack. Feedback from residents able to express their views confirmed they were aware of whom to speak to if they have concerns or complaints. Complaints are logged in a complaint book, with details of the concerns, action taken and outcome and cross–refers to another file with correspondence. The manager investigated nine complaints since the last inspection. Six of these were upheld and it was stated all complaints had been resolved within the Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 23 required timescale. It would appear however that not all complaints were being brought to the attention of the manager and logged on the basis of responses received from a number of relatives who made reference to complaints they had raised with the home. One person also referred to waiting for compensation for loss of an item. The manager is requested to look at record keeping for complaints to ensure a comprehensive record is maintained including complaints investigated by external management. Two complaints had been initially received by the CSCI and referred on to the manager for investigation. The first concerned an allegation of inadequate night staffing levels. Records confirmed a full review of night routines and dependency levels had taken place and a meeting between the manager and night staff .The manager stated she does not hesitate to increase night staffing in circumstances when this is necessary. The second complaint was about the passenger lift, which was not working for a month earlier this year. Though only three years old the lift had a recurrent history of faults and on each occasion long delays in repairs owing to parts having to be shipped from France. The manager stated staffing levels were increased when the lift was not working. Other complaints included one regarding cleaning standards and in response the home instituted daily morning meetings with domestic staff. Another complaint related to staff not observing and reporting significant changes in need of a resident, one of the outcomes being a dietician referral. This complaint was explored further with the manager. Discussed also in the context of concerns during the inspection about record keeping practices and staff’s ability to observe residents’ adequately at mealtimes. Since the inspection visit, comments received from some relatives in response to the CSCI survey include similar concerns. It is recommended that the manager examine the effectiveness of internal complaint mechanisms in view of the number of critical comments received from relatives and other stakeholders during this key inspection. In addition to those already referred to, some relatives are not pleased with standards of cleaning and hygiene in bedrooms. Critical comments about bed making, infrequent linen changes and towels either in need of changing or missing were also received. There needs to be an effective system for monitoring housekeeping standards. Safeguarding adults and whistle blowing procedures were in place. Those staff consulted were clear of what action they would take in response to a suspicion or report of abuse. The manager stated that all current staff had received safeguarding adults and rights and responsibilities training. Training is provided by an external trainer and by the organisation. Staff induction records sampled confirmed adult protection awareness was covered and safeguarding training planned. Fourteen staff had attended training relating to the management of challenging behaviour since the last inspection. Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 24 Six referrals had been made by the home under local multi-agency safeguarding procedures since the last inspection. Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 25 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 19, 22, 23, 24, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, comfortable and overall well -maintained environment. They have specialist equipment they require. Bedrooms are furnished and equipped to a good standard and residents can have their own possessions around them. Attention is necessary to the storage of toiletries, barrier creams and incontinence pads in en suite facilities also to cleaning standards in bedrooms. EVIDENCE: The reception area was welcoming and the building fitted with an entry system for security. The inspector was asked for evidence of identity on arrival. A comment was received from a relative who raised a concern that identification was not always asked for and strangers allowed to move feely round the building at times. Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 26 A tour of the premises was carried out and bedrooms were sampled. The building and décor is overall well maintained though attention is drawn to a comment from a relative that a light bulb on a stairwell has not worked for over a year. Furniture is of a good standard and all areas viewed were comfortable and adequately spacious. These areas were clean and odour well managed in the areas viewed. One relative stated odour control was not good in his mother’s bedroom when he visits. Comment has already made on some adverse comments about cleaning standards from relatives in the complaint and protection section of this report. Conversely ten of the twelve survey questionnaires received from residents confirmed their satisfaction with cleanliness and odour control. A resident commented her personal clothing was very creased after being washed. Discussion with a member of the housekeeping staff confirmed he did not work to a formal, recorded cleaning schedule and used initiative in determining witch bedrooms were cleaned and when. The manager’s attention was drawn to the need for remedial action to some en suite facilities noted by the inspector to be cluttered. Though there is a bathroom cabinet for toiletries, this is quite narrow and a number of residents’ were storing toiletries on washbasin ledges and the toilet cistern. Also in one bedroom two open tubs of AQUA cream with lids off were seen on the washbasin also two razors (non electric type). Clean incontinence pads were piled on floors in en-suite rooms. Bedrooms were nicely personalised and bedroom doors can be secured from inside for privacy. Residents may have items of their own furniture in their rooms by agreement. Keys to bedroom doors are available on request. A lockable item of furniture is standard in all rooms. New furniture was stated to be on order for the lounge reception area. It is planned to replace carpets on the second floor and fit wooden flooring in some dining rooms. All areas are wheelchair accessible. The manager expressed confidence that recurrent problems with the passenger lift earlier this year are now resolved. It was stated that a chair lift is to be installed. The garden was tidy and accessible. Call bells are in all areas and were observed working and staff responding to the same. Low temperature surface radiators are fitted throughout the home and windows have restrictors. Following a risk assessment of the building, additional precautionary measures were stated to be under consideration. Specifically to reinforce residents’ safety when using balconies. Balcony rails were stated to be compliant with the height stipulations of building regulations. Doors leading onto the furnished balconies were noted to be all locked at the time of the visit. Specialist equipment and bathing facilities are provided for maximising residents mobility and independence. Grab rails and other aids, including pressure relieving equipment, hoists and bedrails are provided in accordance Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 27 with individual needs. Kitchen facilities throughout the home were hygienic and well equipped. Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 28 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels need review to ensure needs are fully met and residents safe. A programme of staff training was evidenced and good to see some staff had attended training in managing challenging behaviours. Staff recruitment and vetting procedures were satisfactory. The manager must ensure staff taking up post on the basis of a POVA check prior to a full CRB Disclosure being received are directly supervised when in contact with residents in their rooms. EVIDENCE: The staff team was reported to be stable by the manager with the exception of recent turnover in the senior management team. A number of relatives however gave feedback of their perception of frequent staff changes. The manager confirmed the recent recruitment of a laundry assistant who will work during weekdays. This is a new post and a very positive development. Apart from using valuable care hours for laundry duties a number of incidents of damaged clothing were noted. This employee was currently going through recruitment vetting procedures. Recruitment records for two staff were sampled. Personnel records Were well-organised and statutory requirements met specific to recruitment and vetting procedures. The organisation’s national recruitment team were stated to coordinate recruitment processes. New recruitment retention tools were in place also new induction folders. Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 29 A record of Criminal Record Bureau (CRB) Disclosures for staff demonstrated these had been obtained. The good practice procedure for renewing CRB Disclosures every three years is commended. Attention was drawn to amendments to the care homes regulations and need to ensure supervision of new staff in accordance with the regulations. The manager was advised of the need to ensure formal instructions given to staff for supervision of a new employee who had recently taken up post on the basis of a POVA check. Until such time as full CRB clearance is received he must be supervised in his contact with residents in their rooms. It is acknowledged that mostly this employees duties are in public areas. The composition of the staff team in terms of diversity, ethnicity and culture does not reflect that ethnicity and culture of the residents in this home. The manager was informed of feedback from three relatives who raised this as a barrier to communication for both relatives and residents as it was sometimes difficult to understanding staff’s accents. One relative expressed the view that it must be even more difficult for residents with hearing problems and those with dementia to communicate with some staff for this reason. The manager confirmed the organisation’s central marketing and recruitment team were looking at this at a national level. It is difficult for the home to recruit locally. Throughout the inspection observations and contact with care staff found those consulted had a good command of the spoken English language. This was not always the case for housekeeping staff. Staff were professional in their standard of dress though none of the care staff observed wore name badges. The records of staff training sampled confirmed an ongoing training programme. It was noted that the organisation had temporarily suspended new applications for NVQ training. This was to enable to concentrate on the high numbers of staff across the South East Region found to have enrolled on this training but taking a long time to finish it. 60 of care staff at Linwood was stated to have NVQ Level 2 qualifications and 15 staff to currently be working towards this qualification. Other staff were stated to be motivated and enthusiastic to embark on NVQ Level 3 when permitted to do so. Observations throughout the report highlight the need for review of the adequacy of staffing levels on the ground floor in particular to ensure residents’ needs are fully met and their safety maintained. Information received at the time of the inspection visit and independently from respondents to the CSCI survey following the inspection indicates an increase in staffing levels is possibly needed. Additionally the need for improvement in arrangements for monitoring care practice and supporting staff. Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 30 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards: 31, 32, 33, 35, 37, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is appropriately qualified and experience and has been registered by the CSCI. Long-term absence of senior staff, recent changes of managers and other factors have evidently impacted on the homes management. It is necessary to develop a strategy for raising standards taking into account shortfalls identified during this key inspection. A more robust system needs to be in place for monitoring standards of care and housekeeping practices and care plans and records. Quality assurance systems are in place. Residents’ financial interests are safeguarded. Some shortfalls in health and safety practices need attention. Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 31 EVIDENCE: The manager was present throughout the inspection. Since the last inspection she has been registered by the CSCI. The manager is appropriately qualified and has relevant management experience. She is commitment to her own continuous training and development and is currently studying for a diploma in Dementia Care Matters. The manager transferred from another Anchor home to manage Linwood approximately eighteen months ago. She has managed some difficult staffing issues since taking over the home. Discussion took place on progress being made in changes to practice and culture in the home. Feedback received from a randomly selected care assistant during the visit confirmed a high level of respect for the manager. She described her as very approachable and supportive of staff and residents. “ She always listens and tries to resolve problems”. A night care assistant was also noted to arrive early which was unplanned and wished to discuss her holiday entitlement with the manager. The manager ensured she made time to do so despite being very busy and the pressures of the inspection. The manager reported receiving regular one to one support from her line manager. There is also a national team of staff to offer advice in areas of recruitment, health and safety, human resources, catering, training and a care specialist team. The management structure includes two deputy manager posts, also team leaders, chef manager and administrator. The activity coordinators will in future be part of the home’s senior team. This team has experienced a number of changes in personnel. The former deputy manager is now ‘acting’ manager at another Anchor home. This was stated to be a major upheaval for some residents, staff and relatives as she had worked at Linwood a long time. The other former deputy manager had been absent from work on long-term sick leave and was now on maternity leave. There are now two new deputy managers in post. The title of senior care assistants has changed and they are called team leaders. A new team leader had recently taken up post. Feedback received from a general practitioner confirmed the opinion that senior staff at the home are very good. At the time of the inspection visit one deputy manager and two team leaders were on duty. It is recognised that the senior team is going through a period of adjustment whilst taking on new responsibilities and forming relationships with colleagues. Also that it will take time before senior staff know local policies, the home, residents, staff, relatives and other stakeholders. Additional pressures on the home’s management this year have been the disruption and extra workload for dealing with mites in furniture and carpets in lounges that necessitated all areas twice being fumigated. The month without a passenger lift, organising and supporting staff that was required to transport all meals up and down stairs three times a day and dealing with associated complaints was an Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 32 additional management workload; also a major change to the home’s fire safety procedures and practice earlier this year. There is a need for the management of the home to look at areas of the home’s management to ensure a management plan in place for addressing shortfalls identified at the time of this key inspection. These include improvement to care plans and associated record keeping, review of staffing levels and practice on the ground floor, at specific periods of the day. Feedback from relatives has been mixed and some relatives very dissatisfied with cleaning and hygiene standards in bedrooms. Also with aspects of care, specifically opportunity for baths, adequacy of monitoring fluid intake, management of incontinence and shortfalls in communication. Some relatives stated they were not always made aware of GP visits, changes to medication and of hospital appointments. It is important that the care planning process includes clarification of the level of involvement relatives wish to have and can expect and for this to be agreed by the residents where capable and to be recorded. Other comments from relatives included they would like a mechanism to inform them about key worker changes and relatives who cannot visit often would like to be informed of the names of senior staff. It was suggested the latter would be helpful to ensuring continuity of information as relatives could ask to speak to the same person. A relative was critical of the transfer of out of date information to the new documents e.g. old telephone numbers and stated a lot of mistakes were noted in the information being transferred in the plan this person was asked to look at. In reviewing the home’s internal quality systems it was noted that a questionnaire survey was carried out of residents and overall positive feedback received. It was not clear if relatives and other stakeholders had contributed. There was less satisfaction about activities, which could be anticipated owing to only being one activity coordinator instead of two all year. Other quality systems were noted to include residents meetings and a feedback books about meals. The chef manager stated catering staff read these books and take on board comments and suggestions. They also meet monthly with residents and their ideas for the winter menu were stated to have been incorporated into the draft menu. Various audits are carried out and a monthly quality indicators report is completed and sent to the area manager. Reports of monthly provider visits were sampled. A number of records relating to maintenance, fire and health and safety were examined. These demonstrated residents and staff’s welfare and safety was overall promoted and protected. Some improvement to practice needs to be made in this area however. Staff must to remember to lock cleaning cupboard doors where hazardous products are stored when not in use also cupboards under sinks in kitchenettes. For risk assessments to be in place for storage of external creams and toiletries and shaving equipment in en suite facilities. There is a need to ensure records of fridge temperatures on units are maintained up to date. Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 33 It was noted that a complaint about the lift not working had lead to a review and major change to the homes fire evacuation procedures. Surrey Fire & Rescue Service carried out an audit the outcome of which was the ‘stay put’ policy previously in place had to be changed. The impact of this was a review and change to the fire evacuation procedures necessitating purchase of sliding sheets that are now under most mattresses. Also provision of pads for staff to move people unable to walk down stairs. Staff were retrained in the new evacuation procedures and use of equipment. Throughout the inspection visit a number of residents were observed using their bedrooms for smoking. Since the last inspection a small fire had started in a bedroom of a smoker. Discussion took place with the manager regarding new Smoke Free Legislation and briefing applicable to care homes. This refers to their twelve-month exemption, which permits bedrooms still to be used for smoking provided specific conditions are met. There was one query in relation to these conditions and the manager requested to consult the Environmental Health Department for clarification. Risk assessments have been carried out for smokers and smokers bedrooms identified on fire records and risk assessments The inspector was informed that only staff who are smokers supervise residents who need supervision when smoking in their rooms. An information bulletin is supplied to new residents and/or their representative explaining the organisations policy on handling residents’ money. This includes promoting independence and choice in respect of their finances; encouraging residents to retain full control of their financial affairs and deposit their money with banks or building societies. Where people are unable to manage their own affairs, only if there is no one to do this will staff do so. This is after a formal assessment of needs and with agreement of relevant people. Residents retain control of expenditure of their money and if unable to do so, relatives and representatives are encouraged to take over this responsibility. A new administrator was appointed December 2006 and the inspector briefly met with her to sample financial record keeping systems. Money is held securely in a safe and safe code holders are restricted. Residents have their own named account within Anchors accounting system. All deposits are held in a current account, which does not pay interest, and this is made clear in the bulletin received. Also that there is a maximum amount that can be kept in this account. Statements showing current balance of money and details of transactions were stated to be available on request. Attention is drawn to feedback received from a relative who holds power of attorney that this person would like to receive itemised details of expenditure. A system is in place for deducting expenditure by residents from their accounts. Also for payment for hairdressing and chiropody services and provisions purchased from the home’s shop. Withdrawals and deposits are usually in standard office hours and expenditure by staff on behalf of residents is supported by a receipt system. . Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 34 Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 35 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 3 x x 3 3 3 x 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 x 3 x 1 2 Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 36 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 OP7 OP8 OP9 OP38 Regulation 12(1), Requirement Further attention to care planning and review, assessments and associated record keeping. This includes ensure up to date contact information and other relevant information is documented on care records. Risk assessments for residents and their environment also need further developing. The admission and care planning process needs to clarify expectations and agreements for notification to relatives/representatives of significant information and a record held to improve communication. Requirement relating to care plans part met from the last inspection. 2 OP8 12(1) A review of care delivery and routines is necessary specific to personal hygiene practice and monitoring, management of incontinence and of nutritional and hydration monitoring. A more robust system is necessary DS0000059210.V342338.R01.S.doc Timescale for action 31/10/07 30/09/07 Linwood Version 5.2 Page 37 3 OP12 16(2) 4 OP26 23(2)(d) 5 6 OP27 OP18 18(1)(a) 13(6) for monitoring care practice. For further review of arrangements for activities in consultation with them about their social interests. The activities programme needs to be expanded and provide suitable activities having regard to their needs and capabilities. For a more robust system to be in place for monitoring standards of cleanliness and hygiene in bedrooms. For care staffing levels during the day at peak period on the ground floor to be reviewed. For formal arrangements to be made for staff taking up post who have not received a CRB Disclosure to be directly supervised in their contact with residents in their bedrooms and delivery of personal care. 30/11/07 30/09/07 30/09/07 01/09/07 Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 38 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 OP8 Good Practice Recommendations For action planned to carry out work to balconies as an additional safety precaution to be progressed in order that residents living on these units who may not wish to leave the familiarity of their environment can benefit their health from opportunity to be exposed to sunshine. For care staff to wear their name badges. For residents to be consulted about the gender of care staff providing intimate personal care. For management systems to ensure feedback to the manager of concerns and complaints arising out of review meetings and arrangements made to follow up and monitor the areas of concern. For review of the adequacy of storage provision for toiletries in en-suite rooms. For cleaning schedules to be implemented for housekeeping staff. For fragmented record keeping practices relating to care to be reviewed. For care staff to wear protective clothing when serving food. For the Environmental Health Department to be consulted and clarification obtained of conditions to be met for residents who continue to smoke in their bedrooms. 2. 3. 4. OP12 OP10 OP16 5. 6. 7. 8. 9. OP24 OP26 OP37 OP38 OP38 Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Oxford Office 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU 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 Linwood DS0000059210.V342338.R01.S.doc Version 5.2 Page 40 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!