Inspection on 01/08/06 for The Lindens

This inspection was carried out on 1st August 2006.

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 but made no statutory requirements on the home.

Other inspections for this house

The Lindens 19/11/08

The Lindens 20/06/08

The Lindens 25/06/07

The Lindens 31/01/07

The Lindens 10/11/05

The Lindens 19/04/05

The Lindens 24/09/04

The Lindens 04/05/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE The Lindens Stoke Hammond Bucks MK17 9BH Lead Inspector Chris Schwarz Unannounced Inspection 08:45 1 August 2006 st 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 The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 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. The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Lindens Address Stoke Hammond Bucks MK17 9BH 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) 01908 371705 01908 375075 N/A Mr Michael Hannelly Linda Rose Howell Care Home 17 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (17) of places The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for up to 17 service users, up to five of whom may have dementia. 10th November 2005 Date of last inspection Brief Description of the Service: The Lindens is a privately owned care home and is registered to provide residential and personal care for up to 17 older people. The home is situated in a rural area on the outskirts of the village of Stoke Hammond and is within easy distance of Bletchley and Milton Keynes. The home is a large detached Edwardian house set in accessible, extensive grounds. The house has been subject to a programme of refurbishment to comply with the current standards. All rooms are single and have en suite shower and toilets. Additional assisted bathrooms and toilets are provided. There are two good-sized social areas for service users on the ground floor. There is a team of carers who provide support to residents during the day and two staff awake at night to assist residents who may need help. Fees range from £375 to £550, according to information supplied with the preinspection questionnaire. The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over the course of one day and covered all of the key standards for older people. Prior to the visit, a questionnaire was sent to the manager alongside comment cards for distribution to service users, relatives and visiting professionals. Several replies were received from the comment cards. The inspection consisted of discussion with the manager and some of the staff team. There were opportunities to observe care practice and to speak with service users to gain their views. A tour of the premises and examination of some of the required records was also undertaken. At the end of the inspection, feedback was given to the manager and deputy manager. The staff team is thanked for co-operating with this unannounced inspection and for their hospitality throughout the day. What the service does well: What has improved since the last inspection? The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 6 The manager has been registered with the Commission. The format for providing references for staff has been revised to allow space for the referee to sign, date and add their position to the information. A fire based risk assessment has been undertaken. All radiators have been covered, to reduce the risk of accidental injury. What they could do better: Assessment of prospective service users is insufficient to establish their care needs and how these are to be met. Care plans and accompanying risk assessments provide insufficient detail of needs with little evidence of review. This could mean that care does not fully meet their needs. The policies relating to health care need reviewing, to ensure that best practice is followed. Medication practice needs improving, to ensure that service users receive the medicines they require and in accordance with the precriber’s wishes. The range of activities for service users is narrow, providing insufficient opportunity for variation and stimulation. There are adult protection and whistle blowing policies and these need to be supplemented with annual revision and training for staff to adequately protect service users from the risk of harm. The premises are not being adequately maintained, detracting from the presentation of parts of the home and placing service users, staff and visitors at risk of harm. The staff team collectively does not have the necessary qualifications to ensure that service users are in safe hands. The home does not use robust recruitment procedures, potentially placing service users at risk of harm from unscrupulous persons. Training is insufficient to meet the needs of service users, which could mean that service users are not fully protected and safe. There is insufficient quality assurance at the home to ensure that standards are met and service users receive the care they require. The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 7 Health and safety is being compromised at the home, placing service users, staff and visitors at risk of harm. The new certificate of registration needs to be displayed. 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 Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 8 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 The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Assessment of prospective service users is insufficient to establish their care needs and how these are to be met. EVIDENCE: An initial assessment tool is used at the home, covering aspects of care such as mobility, transfers, eyesight, communication, eating and drinking and social skills, with a scoring system from 0 to 4. Two assessments were looked at and whilst they provided a basic awareness of some of the service users’ care needs, not all of the sections had been completed, the assessments were not signed and dated and had not been added up to reflect the level of need. There was nothing to give a picture of what the person’s life had been like such as their previous occupation, interests, dreams and aspirations. A more holistic approach needs to be taken, as well as a completed physical care checklist. A requirement is made to address this. Intermediate care is not provided at this home. The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Care plans and accompanying risk assessments provide insufficient detail of needs with little evidence of review. This could mean that care does not fully meet service users needs. Health care needs are being met although the policies guiding staff need reviewing, to ensure that best practice is followed. Medication practice needs improving, to ensure that service users receive the medicines they require and in accordance with the precriber’s wishes. EVIDENCE: Service user plans are in place and a couple were examined. One file contained documentation such as a photograph of the person, an outline of needs, a review sheet dated February this year, a copy of a notifiable incident report, one accident report and night time care needs (undated and unsigned). The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 11 Risk assessments for this person were on one sheet of paper, with insufficient detail to outline the level of risk (low, medium, high), how the risk could be reduced and there was no evidence of reviewing. An example of insufficient detail is “There is a risk of spasmodic confusion” with no further information, dated March 2004, and “Wandering risk and wishing to leave the building. Medication prescribed”. There was no detail of what steps staff might take with the service user, such as perhaps escorting him around the garden, which he enjoys, diversionary measures if agitation is evident and at what stage the medication (to be named and dosage details included) is to be given. A detailed manual handling risk assessment was not in place, it just referred to the fact that staff help was needed. On a positive note, there was a letter from the doctor saying thank you to the staff team for providing a detailed letter regarding the service user’s condition. For the other service user, the file did not contain a photograph. The person had diabetes which was referred to in brief and insufficient terms, dietary needs were recorded as “very finicky. Has a job to chew meat”. The person was said to be prone to urinary tract infections, due to an indwelling catheter, but there was nothing to elaborate on how infection may be kept at bay, such as encouraging regular drinks, especially water. Risk assessments were in the same shape as the other file examined, with insufficient information, no level of risk identified and ways to reduce risk insufficiently explored and no date of review added. Pressure area assessments were not in place for either service user although a blank format was seen in one of the files. Service users are registered with various doctors and there was evidence on files of liaison with surgeries. District nurses visit the home as necessary to undertaken nursing tasks, such as administration of insulin. Access to specialised services such as a community psychiatric nurse was evident, from information on the files, and a record of health care appointments showed that eye checks had been carried out earlier in the year and there is input from a podiatrist. Referral had been made to the dietician for some advice. Service users are weighed regularly and sit on scales had been purchased to facilitate this. Health related policies were in place at the home although several of these were dated 2002, 2003 and 2004, with no evidence of review. At least annual reviewing is needed, to ensure that best practice is being followed. Medication practice needs some attention. A monitored dose system is used at the home and medicines are appropriately stored in a locked and secure cabinet. One controlled medication was double locked with a separate recording log and stocks tallied with the recorded balance. There were some gaps alongside prescribed dose times on medication administration records. Several entries on the medication administration records had been hand The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 12 written by staff without the initials of a second person to ensure that the details were correct. Promazine was recorded as “as required” on the printed record sheet but was said to be a regular three times a day now. This needs to be verified and the record sheet amended if need be. There was no protocol in place to advise staff on the use of promazine under “as required” direction and the manager is to ensure that any “as required” medicine has an individual written protocol, to ensure that staff administer in a consistent manner and that should regular use be evident, referral is made to the prescriber to review needs. One person was being enabled to manage part of her own medication with a written letter of agreement to this by the doctor on file. Health and personal care in practice was more positive. Service users appeared well groomed, with the men shaven, and clothes ironed, matching and appropriate to the weather conditions. A member of staff was seen cleaning a pair of service user’s spectacles and staff were heard speaking to service users respectfully. Call bells were not ringing for long periods of time, staff answered a demonstration call of how the system works very promptly and none of the service users were heard shouting for attention during the course of the day. Care was carried out in private areas of the home and staff were seen wearing protective items. Feedback from a doctor said “Staff always helpful. Seems good atmosphere when visiting. Residents seem happy and well cared for.” The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The range of activities for service users is narrow, providing insufficient opportunity for variety and stimulation. Contact with family and friends is encouraged, maintaining important social relationships. Service users have choice and control in their lives, promoting well-being. Varied and wholesome meals are provided in an attractive setting, meeting nutritional needs. EVIDENCE: Some relatives visited the home during the afternoon and they were made to feel welcome by staff and were offered hospitality. There were no organised activities taking place; staff said that a music man visits once a month and there are crafts that some people take part in such as cross stitching and knitting. Clergy visit the home and newspapers and magazines can be provided on request. One service user was enjoying doing sudoku. The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 14 There is a regular hairdressing service for anyone who wishes to have their hair done at the home. Trips out did not feature in the range of activities that the manager discussed and it seemed that regular opportunities for stimulation were not part of the planning for the home. The whole range of activities and opportunities for stimulation needs to be developed to offer service users variety and to stave off boredom. The home does not manage any of the service users’ finances. A tour of the building showed that service users are encouraged to bring personal effects into their rooms to personalise them and some were particularity homely. Menus submitted to the Commission showed a range of meals are on offer to service users. The lunchtime meal consisted of chicken soup, sausage casserole with mashed potato, cabbage and runner beans with semolina for dessert. There was also fresh fruit available in the dining room and an alternative had been prepared for anyone not wanting the casserole. The dining area had been very attractively set with floral table cloths, napkins, attractive napkin rings and flower arrangements on the tables. Music was played at lunchtime, creating a positive atmosphere in which to enjoy a social gathering. Those requiring assistance to eat were given it. The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There is a complaints procedure for service users or their representatives to use, so that their views are listened to. Service users’ legal rights are protected, ensuring that their rights are respected on entering care. There are adult protection and whistle blowing policies and these need to be supplemented with annual revision and training for staff to adequately protect service users from the risk of harm. EVIDENCE: There is a complaints procedure, written in plain language and presented in a helpful pamphlet style, with a suggested format which complainants may wish to use. The complaints log had no entries since 2002 which may reflect that no formal complaints have been made or that the log book is not used. At the last inspection, a recommendation was made to ensure that a record of informal and formal complaints is kept and analysed to ensure that residents and staff views are acted upon. The recommendation is repeated for attention. People responding to the comment cards indicated that they knew how to make complaints and the Commission has not received any complaints. The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 16 The home’s adult protection policy is dated 2003 and shows no sign of being reviewed. There is a whistle blowing policy dated 2004 and a policy on handling abuse, aggression and harassment from service users, written in 2004. All of these policies need to be reviewed to ensure that they provide adequate safeguards. Some staff had attended Protection of Vulnerable Adults training but not all. This should be viewed as a mandatory course for all staff and a suggestion was made to make use of the free training provided by Buckinghamshire County Council and for the manager to consider undertaking a train-the-trainer Protection of Vulnerable Adults course. The Commission is not aware of any adult protection issues for this service. There was evidence that service users’ legal rights are protected. A copy of a letter from a district council confirmed that a service user had been changed to the relevant Electoral Register. There was also a copy of a completed application to vote by post until further notice on a service user’s file. The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The premises are not being adequately maintained, detracting from the presentation of parts of the home and placing service users, staff and visitors at risk of harm. The home is clean and hygienic, reducing the risk of infection to service users. EVIDENCE: The approach to the home reveals a large detached Edwardian country house, in its own grounds next to the canal. A planning application notice was observed on turning into the driveway. The gardens are well maintained and the front has a ramped access route as well as steps. Visitors need to ring the door bell to be let in and are encouraged to use alcohol rub before coming in. The entrance hall is grand with a sweeping staircase and marble pillars and has two large rooms leading off, one the lounge and the other a second The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 18 lounge/dining room. There is one ground floor bedroom and the kitchen, office and staff room lead away from one of the lounges. Aside from the staff kitchen, the communal ground floor areas are clean, well maintained, attractive and create a positive atmosphere. The staff kitchen has a browning ceiling and walls and should be redecorated. Accommodation for sixteen of the service users is on the first or second floors, with stair lift access. All bedrooms are single and thus there are no issues with privacy and when service users want to be alone they have private space to retreat to or to see their visitors in if they choose. Rooms have been personalised to different degrees with furniture, ornaments and family photographs and each room was well ventilated, had a large window and sufficient natural light coming in. However, six bedrooms had signs of water damage from above. Various degrees of discoloration to the decoration showed that some of the damage is likely to have happened a while back and areas highlighted for attention at the last inspection had not been rectified. One bathroom also had a badly stained ceiling, again from water damage. Repair to the roof is to be undertaken most urgently now and decoration of bedroom/bathrooms affected, to restore the appearance of the home. A sash cord needs to be repaired to one of the large stairwell windows. Curtain track in room 5 had come loose, room 2 carpet was stained and the room needs redecoration. Room 7 had lots of cabling by the window, presenting a trip hazard, shampooing is not removing the odour in the carpet in room 16 and the grouting in the shower at the bottom is brown, plus there is a stain possibly from bleach where the carpet joins the shower room. Carpet in this room should be replaced with more appropriate polypropylene carpet. The curtain track in room 11 had come unattached at one end and the window frame needs repainting. The shower head was not attached to the hose in room 4. The towel rail in the bathroom in room 9 was unattached on one side. Carpet in room 17 was odorous and will need to be replaced if shampooing does not remove the odour. Lino is coming away to the top step by the office and needs to be reaffixed. A roll of carpet on the first floor bathroom was removed at the time of the inspection, as was a kettle from the kitchenette on the second floor which had some discoloration to it. Several outside windowsills were peeling, revealing the wood underneath. A programme of external decoration also needs to be undertaken. The laundry is compact. Staff considered that the one machine, with sluicing programme, was sufficient for the home and care was taken in handling The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 19 service users’ clothing. Staff were observed wearing protective items when needed and all carers wore small bottles of alcohol rub. Requirements are made to improve the quality of the environment, the most urgent being repair to the roof. The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. There are sufficient staff on duty to meet the needs of service users. The staff team collectively does not have the necessary qualifications to ensure that service users are in safe hands. The home does not use robust recruitment procedures, potentially placing service users at risk of harm from unscrupulous persons. Training is insufficient to meet the needs of service users, which could mean that service users are not fully protected and safe. EVIDENCE: There were three carers on duty, one a senior, plus the manager, a cook and domestic worker. Whilst not technically on duty, the deputy manager was also present and took an active part in the inspection process. This complement of staff seemed to be sufficient for the needs of service users, with no evidence of people being rushed or flustered or service users calling out for help. There are currently two waking night staff and most of the staffing hours were filled, with a relief worker picking up some occasional shifts. The lack of progress in meeting National Vocational Qualification Vocational Qualification targets was a concern at the last inspection. Various staff met The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 21 during the inspection were in the process of doing their National Vocational Qualification, including the manager and deputy undertaking the Registered Manager’s Award. Information supplied with the pre-inspection questionnaire states that three have already achieved at level 2 or above. This is still below target. A progress report is to be sent with the action plan, outlining who is doing National Vocational Qualification and how many units have been achieved, plus details of enrolling other carers. Recruitment files of three new staff were looked at. A gap to employment history of three years was evident in one file, with no record to explain what the person was doing during that time. A reference had not been taken up from the most recent employer and there was no photograph of the member of staff. In the second file there was no reference from the most recent employer and no photograph, and for the third person all checks had been completed but there was no photograph. The manager is to ensure that all of the required recruitment document checks are in place before staff work at the home and that any omissions in employment history are pursued and recorded. Training records of a sample of staff were examined. As mentioned earlier in the report, input on Protection of Vulnerable Adults is required for all staff and should be viewed as a mandatory course with an annual update. The first record looked at showed that manual handling, fire safety and first aid had not been completed. The second was up-to-date with most mandatory courses, other than Protection of Vulnerable Adults and fire safety, and the person had attended a course on dementia awareness. Other staff should complete this also, in line with the home’s revised certificate of registration. The third record was missing Protection of Vulnerable Adults input and fire safety. Manual handling, fire safety and Protection of Vulnerable Adults was needed for a fourth person who is part of the catering team, an update was needed in moving and handling and Protection of Vulnerable Adults for a fifth person. One person has completed a mental health programme which is positive, and there was evidence on some files of oral care and medication practice courses. Some staff had attended training in the past couple of weeks on fire safety, which may cover the people identified in the report, but there was no record of who attended, with certificates awaited. A notice on the board in the staff room advertised two forthcoming training events on manual handling during August; the manager will need to ensure that those staff who have not had this training within the past year attend. Evidence of induction was available for the two new carers, with the checklist completed to the stage the new starter had reached. The format does not The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 22 include input on complaints, adult protection and whistle blowing and these should be added. There was no induction for the domestic worker, which is a concern as infection control, health and safety and control of substances hazardous to health are vital, as well as a broader introduction to the home and philosophy of care. An induction is to be devised for this post and carried out with the person as soon as possible. Staff had not received copies of the General Social Care Council code of practice. The number was given to the home to obtain free copies for each person working there. The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home has an experienced manager, to ensure that the home is effectively run and needs are met. There is insufficient quality assurance at the home to ensure that standards are met and service users receive the care they require. The home does not handle service users’ money. Health and safety is being compromised at the home, placing service users, staff and visitors at risk of harm. The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 24 EVIDENCE: The home has a registered manager who has the necessary experience to run a home for older people. She is undertaking the Registered Manager’s Award and was seen to be approachable to service users, staff and visitors. Until she had achieved the Award, the standard cannot be scored as fully met. The deputy manager is also experienced, approachable and undertaking the Award. Both have undertaken periodic training and there are clear lines of accountability within the home. The home’s registration was revised in March this year, to accommodate up to five service users with dementia. The new certificate was not displayed at the home. A quality assurance checklist was seen in service users’ files, most recently completed in June this year. A requirement for a systematic quality assurance programme to be implemented was not evident, although the manager and deputy manager have recently undertaken training to facilitate this in future. Reports of monitoring visits by the provider were not available at the home as required. Only two reports have been sent to the Commission this year; a requirement made at the last inspection for monthly monitoring visits to be undertaken and the reports forwarded to the Commission is not being met. The home does not handle service users’ finances. It was possible to see that a receipt was issued to a relative presenting a cheque to the home. The fire log showed that weekly testing of the alarm system is undertaken, there are regular drills (for day, night and new staff), emergency lighting is checked and the system serviced by an external contactor. Extinguishers had been serviced in August last year. A fire risk assessment commissioned by the providers in January this year stated that the highest risk of fire on the premises was from the combustible material being stored in the cellar. It was therefore surprising to see a large quantity of unused furniture stored there; it is worrying that the provider has not responded to a risk classed as urgent and this too must be attended to with the utmost urgency. Water was tested in most areas of the home and found to be better regulated. The hottest water in a bedroom was found to be 45°C, still within the acceptable temperature range. Radiator covers had been fitted, as required. The manager confirmed that there is no programme of descaling shower heads, which needs to be done and a record kept of the dates. The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 25 There was no evidence that a requirement to service the boiler had been complied with. There was no evidence that a requirement to forward a copy of the Legionnaire’s testing report had been done, nor that the fire officer had been contacted regarding the acceptability of the lack of emergency lighting in the lounge and dining rooms. A health and safety file had been set up, as required at the last inspection, with useful information for staff. As mentioned under the staffing section of the report, it is not evident that all staff have up-to-date manual handling training or that all carers who handle food have food handling and hygiene training. The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 26 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 x x 1 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 1 x x x x x x 3 STAFFING Standard No Score 27 3 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 1 x N/a x x 1 The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 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 OP3 Regulation 14 Timescale for action Initial assessments are to be 01/10/06 completed in full, signed and dated and information about the person’s background, social interests, hobbies, religious and cultural needs given more attention. Care plans are to be in sufficient 01/12/06 detail to outline service users’ needs, including assessment of pressure areas, and how these are to be met, with evidence of regular review and revision where necessary. Dates and signatures are to be added. Individual risk assessments are 01/12/06 to be devised for each service user. These are to be in sufficient detail to identify the risk, level of risk and actions to be taken to reduce risk, with evidence of at least annual review. Dates and signatures are to be added. Health care policies are to be 01/11/06 updated and reviewed at least annually. Medication administration 01/10/06 records are to be accurately DS0000028059.V289395.R01.S.doc Version 5.1 Page 28 Requirement 2 OP7 15 3 OP7 13(4) 4 5 OP8 OP9 10(1) 13(2) The Lindens maintained. 6 OP9 13(2) A second person is to verify hand written entries onto the medication administration records. Verification is to be sought on whether the promazine is still to be given “as required” or three times daily and the administration record amended if necessary. Individual protocols are to be in place for any “as required” medicines. The range of activities and opportunities for service users to be stimulated is to be developed. The policies on Protection of Vulnerable Adults, whistle blowing and abuse, aggression and harassment from service users are to be reviewed. All staff are to have attended Protection of Vulnerable Adults training with at least annual update, which could be done by a certificated train-the-trainer in house. Maintenance and safety issues identified within the report are to be attended to. The roof is to be repaired. Redecoration is to take place to those rooms requiring it, especially those where water damage is evident. A plan is to be submitted with the action plan to this report, outlining which carers have achieved at least level 2 National Vocational Qualification, who is undertaking it and which units have been covered, plus details of enrolling other carers. The full range of schedule 2 recruitment checks is to be in DS0000028059.V289395.R01.S.doc 01/10/06 7 OP9 13(2) 01/10/06 8 9 10 OP9 OP12 OP18 13(2) 16(2)m,n 13(6) 01/10/06 01/01/07 01/11/06 11 OP18 13(6) 01/03/07 12 13 14 OP19 OP19 OP19 23(2) 23(2) 23(2) 15/10/06 15/11/06 01/01/07 15 OP28 18(1)c(1) 15/09/06 16 OP29 19(1) 01/09/06 The Lindens Version 5.1 Page 29 17 OP30 18(1)c(1) 18 19 OP30 OP30 18(1)c(1) 13 20 OP33 24 place before staff start working at the home. Gaps in employment history are to be pursued and recorded. All staff must have manual handling training with annual updates Previous timescales of 31/07/05 and 31/01/06 not met. Mandatory training is to be brought up-to-date and maintained as such. All staff must have induction training. Previous timescale of 31/07/05 and 31/01/05 not met. An induction programme for the post of domestic worker is to be devised and carried out with the person. A systematic quality assurance programme must be implemented Previous timescale of 31/07/05 not met. 01/11/06 01/11/06 01/10/06 01/10/06 21 OP33 26 The responsible individual must 01/09/06 make monthly visits to the home and send a copy of his report to the Commission for Social Care Inspection on a monthly basis. Previous timescales 31/7/05 and 31/12/05 not met. The furniture and other combustible material in the cellar is to be removed. Shower heads are to be regularly descaled with a record kept of when this is done. The boiler must be serviced. Previous timescale of 31/01/06 not met. Evidence of boiler servicing is to be kept on the premises. The report of the Legionnaires assessment must be sent to The Commission for Social Care DS0000028059.V289395.R01.S.doc 22 23 24 OP38 OP38 OP30 23(4) 13(4) 13(4) 01/10/06 01/10/06 01/10/06 25 OP38 13 01/10/06 The Lindens Version 5.1 Page 30 Inspection 26 OP38 13 All carers who handle food 01/11/06 should have food hygiene training. The revised certificate of 01/09/06 registration is to be displayed in the home. 27 OP38 Care Standards Act 2000, part 2, section 28(1) 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 OP16 Good Practice Recommendations A record of informal and formal complaints should be kept and analysed to ensure that residents and staff views are acted upon. Each person working at the home is to be given a copy of the General Social Care Council code of practice. Dementia awareness training should be rolled out to all staff. 2 3 OP29 OP30 The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Lindens DS0000028059.V289395.R01.S.doc Version 5.1 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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