Inspection on 20/06/08 for The Lindens

This inspection was carried out on 20th June 2008.

CSCI found this care home to be providing an Poor service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Lindens 19/11/08

The Lindens 25/06/07

The Lindens 31/01/07

The Lindens 01/08/06

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE The Lindens Stoke Hammond Buckinghamshire MK17 9BH Lead Inspector Jane Handscombe Unannounced Inspection 10:50 20th June 2008 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.V365607.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. The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Lindens Address Stoke Hammond Buckinghamshire 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 Mr Michael Hannelly 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.V365607.R01.S.doc Version 5.2 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. 25th June 2007 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 £386 to £600 per week. The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced key inspection, which took place over 2 days. The visit took place on the 19th and 20th June 2008. The purpose of the visit was to see how the home is meeting the National Minimum Standards. Results of this inspection report are derived from feedback gained from surveys sent out to people using the service and visiting professionals, discussions with service users and with staff during the visit, viewing client’s records held within the service, viewing policies and procedures, staff personnel files, general observation throughout the day, along with information provided to us within the AQAA, a pharmacy inspection undertaken by the Commission in October 2007 and any other information that CSCI has received about the service in order to gain an understanding of how the service meet the service users’ needs, and impact upon their lives. A tour of the home was undertaken, care plans were examined and meeting the residents to see if the care plans gave a true reflection of their care needs and how these were being met followed this up. The inspector met with residents, staff, visiting professionals, relatives and friends to find out their views on how well the service is doing. Records required by regulations were examined, including staff files and the home’s policies and procedures. We looked at how well the home was meeting the key standards set by the government and have in this report made judgements about the standard of the service. Comments received from those using the service include: ‘Its always clean, clean bedroom everyday’ ‘the meals are very good’ ‘the family visit they are always made welcome’ ‘the gardens are lovely, the gardeners been putting flowers out’ ‘I would recommend The Lindens to others’ ‘I’m well looked after’ ‘the staff are ever so good, very obliging’ The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 6 The inspector would like to thank all those who gave their time during the inspectuion process. What the service does well: What has improved since the last inspection? Since the last inspection, a new care plan format has been put into place providing for a more detailed individualised plan of care. Residents meetings are now held to gain the views of people using the service on various aspects within the home. Staff are more involved in the care planning process. The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 7 What they could do better: Whilst there is some improvement to address requirements made at previous inspections, more work is needed to ensure the home promotes quality care for those using the service, which meets their health, social and personal care needs appropriately and in a safe manner for which the following requirements and recommendations have been made. Ensure that all risk assessments and documents within care plans are completed and kept up to date and gain the service users’/representatives signature to evidence their involvement in the process. Ensure that a photograph is held on each service users file. Ensure that arrangements are in place for the safe storage of medications at all times, including those for returns A system for identifying and monitoring any maintenance and health and safety standards must be put into practice; this is a repeated requirement. The registered provider must undertake monthly quality assurance visits to the home and prepare a written report of the findings and the actions to be taken to improve the service; this is a repeated requirement from previous visits. Ensure a robust recruitment procedure is in place and that all necessary checks are obtained prior to a new member of staff commencing employment to ensure their suitability to work with vulnerable adults and to ensure the health, safety and welfare of those using the service. Duty rosters highlighted there were insufficient numbers of staff to meet service users needs during the night shift. The ratio of care staff to service users needs be determined according to the assessed needs of residents and a system operated for calculating staff numbers required, in accordance with guidance recommended by the Department of Health. Ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of those using the service. Ensure that staff are appropriately supervised whilst awaiting their full CRB Ensure to register a permanent manager of the home with CSCI. Hazardous substances must be stored securely at all times to ensure the health, safety and welfare of those using the service. The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 8 Ensure that CSCI is notified of any accidents/incidents as listed under regulation37 within 24 hours. It is strongly recommended to consider more robust arrangements for the recording of staff who administer medication, as discussed with the manager 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. The Lindens DS0000028059.V365607.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 The Lindens DS0000028059.V365607.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): 3, standard 6 not applicable to this home. Quality in this outcome area is good. Appropriate systems are in place to ensure any potential admissions to the home have their needs assessed and are provided with an opportunity to visit the home to ensure that it is suitable and able to meet their needs appropriately This judgement has been made using available evidence including a visit to this service. EVIDENCE: Prospective users of the service receive an assessment of their health, personal and social care needs and introductory visits to the home are provided prior to any final placement decisions, this is to ensure that both parties are confident that their needs can be met appropriately. The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 11 The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is adequate. 7, 8, 9 and 10 There are insufficient levels of appropriately trained competent staff on duty between the hours of 9pm and 8am, to ensure that peoples care needs are fully met. There are some poor practices taking place around the storage of medication which could compromise service users health, safety and well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service have since the last inspection transferred service users care plans to a new format to allow for more detail and ensure it is more individualised. It details what the service users requires the staff to do for them and the required outcomes thus providing staff with a good overall picture of their needs and how these are to be addressed. The service users care plans are used in conjunction with a book detailing a variety of different assessments which include assessments relating to the persons social activities interests The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 13 hobbies religious and cultural needs, their mental state and cognition, their physical health, moving and handling, skin viability, nutritional screening, falls, personal safety and medication usage, foot care and continence. However, staff need to have a reasonable command of the English Language in order to understand the contents of the care plans to ensure that there is no detriment to the welfare and safety of service users. Four service users plan of care were viewed during our visit. The files viewed contained assessments detailing how their needs were to be met, although some of these were not signed by either the service user/their representative to indicate their involvement or signed by that of the person who undertook the assessment and some files contained blank documents that had not been completed. One of the files viewed informed us that the risk assessments had been undertaken in 2006, with no documented evidence that they had in fact been reviewed apart from one assessment relating to moving and handling that was dated 2008. There were further details within this service users file which informed us that he/she had been taken to hospital for one night following a fall. It is a requirement that the registered person must notify CSCI of any such events however we were not notified of this event as is required under the Care Homes Regulations 2001. The second service users plan of care contained a document headed ‘personal safety and medication usage needs and what staff need to do for me’ this document had not been completed, likewise a document relating to this service users interests, hobbies, social activities, religious and cultural needs was also blank. A further file informed us that the service user received oxygen therapy and whilst there was a printed guide to oxygen therapy providing staff with information, there was no risk assessment in place relating to this. Also within this file it stated that ‘I am not confident since my fall and I need staff to support me in any manoeuvres’; there were directions to staff that a moving and handling assessment was to be completed on a monthly basis or more frequently if required and when we asked to see the assessment book it became apparent that an assessment book had not been completed for this resident. A further shortcoming was that in which people’s files did not always contain a photograph of the service user. Whilst a number of requirements have been made to address the shortcomings, information provided to us in the AQAA tells us that the provider recognises that they could improve upon the auditing of care plans and plans are in place to undertake a full audit in the coming months. Records of reviews of care, visits to or from the local doctors, visits from community nursing services and other health care professionals are recorded within the service users’ files indicating that their health care needs are being reviewed and met appropriately. The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 14 We spoke with a healthcare professional, who had come into the home to attend to a service user, and she informed us that they have good working relationships with the home; that they always follow any advice given and access their services appropriately. Staff encourage individuals to be independent and are aware of the need to treat individuals with respect and to consider their dignity when delivering personal care. Discussions with those using the service informed us that the staff are always respectful and ensure their dignity is maintained when delivering their personal care. It was noted that consideration is given to the persons choice of gender of staff when providing personal intimate care which is documented within their care plans. During this visit we met with service users and through discussions with them, it was ascertained that they feel that the carers treat them with respect and that their dignity is upheld. People using the service are enabled to maintain responsibility for their own medicines within a risk management process and policies are in place to enable them to do so, although these were not seen to be put into practice; During our visit we toured the home and found two bathrooms to contain service users prescribed creams being stored inappropriately and accessible to others; these findings were reported to the acting manager who assured us this would be addressed appropriately and a requirement has been made within this report to ensure that medications are stored safely at all times. Records are kept for medicines received into the home, those administered and those leaving the home. However, the home uses a system of recording numbered codes to identify the staff who administer medicines, the system was in use when we undertook a specialist pharmacist inspection in October 2007 at which the pharmacist inspector recommended this practice be reviewed to consider more robust arrangements. A repeat recommendation has been made within this report to address this issue. Recommendations are seen as good practice and should be given serious consideration. A further shortcoming around medication was that in which a medication prescribed for a service user was found in the medication cabinet which was clearly marked upon the label to use before May 2008. The acting manager removed it from the cabinet and placed it for returns to the pharmacist. Correspondence from the registered responsible person informs us that they are planning to audit their medication systems and that in the next two weeks from the date of our visit they plan to support all staff to undertake a MDS (monitored dosage system) workshop as a refresher, to reinforce good practice and supports the 12 week college course on medication administration which staff attend. The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 15 . The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 16 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): 12, 13, 14 and 15 Quality in this outcome area is good. People living in the home are provided with a pleasant and relaxed environment. Meals are home-cooked, nutritious and nicely presented with an alternative available for those who require. Whilst the service users are helped to exercise choice and control over much of their daily lives, this does not extend to choosing a time suitable to them when they wish to retire to bed, rather this has been made for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Whilst people using the service generally feel that the lifestyle experienced in the home serves their preferences, it was apparent that there is little consideration given to people’s choice in the time of their retiring to bed. Discussion with a staff member informed us that people using the service generally are in bed between 8pm-9pm sometimes a little later although “recently try to get them all in bed by 9pm” When asked if they could choose The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 17 to stay up longer we were informed that this was not possible. On the second day of the visit, it was reassuring to note that this issue had been addressed immediately; the registered person had been made aware of our findings the previous evening and addressed the issue; he had placed a notice on the office notice board informing staff that service users could choose to retire to bed at a time suitable to them. The home encourages residents to maintain links with family, friends and the local community and support is given to maintain contact where required. Residents are able to receive visitors in private and choose who they do/do not see. Those spoken to during this visit confirmed this to be the case and one service user told us ‘the family visit they are always made welcome. X (named staff member) is a lovely woman, she makes anyone welcome…really looks after you’. Residents explained that they enjoy wholesome meals, which offer variety and choice according to their wishes, all of which are prepared freshly on the premises. Service users likes and dislikes are respected with a choice being offered where the need arises. Cereal and toast are served at breakfast although a cooked breakfast can be offered if a resident wants one. The main meal is served at lunchtime and a light cooked supper or sandwiches are served at suppertime. The last meal is at 6 pm with drinks and biscuits being served later in the evening. The dining tables were laid attractively on the day of the unannounced visit and the mealtimes were seen to be a sociable occasion for residents. Assistance is given in a discreet sensitive manner to those who require. Information provided to us from the service, prior to our visit, informs us that menus are now discussed at residents forums and any changes according to people’s wishes are to be implemented. Comments from those using the service around the food provided were generally very positive; comments included ‘the meals are lovely, we have a three course meal everyday and I have breakfast in bed’ ‘meals are very good’. One family member tells us that ‘sometimes tea is not suitable as difficult to eat – this is hopefully going to be addressed as has been pointed out to staff’. Information provided to us prior to our visit tells us that activities are provided twice a day when people using the service want it, however on the day of this visit, it was noted that there were no organised activities taking place. In response to the question ‘are there activities arranged by the home that you can take part in?’ the two surveys we have received both answered ‘sometimes’ with an added comment from one which tells us ‘ I think an effort has been made to improve this. It would be nice for the staff to be able to spend time with residents and take them outside when suitable this is dependent on staffing’. Comments through discussion with a member of staff include: ‘I think residents are bored very often, not enough entertainment, I’d The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 18 like to have more time with the resident’. Speaking with residents during this visit confirmed that there are not many activities provided however, the service recognises that the activities provided are often spontaneous and not always planned and plan to discuss activities with residents and how they would like to be more involved in the running of the home. Likewise, a representative from the home is attending a quarterly activities co ordinators’ forum enabling her to network with others and gain further ideas on broadening upon the activities offered to those living at The Lindens. An outside entertainer visits the home on a fortnightly basis and fortnightly themed talks are provided enabling service users to discuss topical issues and air their views. In discussion with people using the service it was ascertained that the outside entertainer is enjoyed by all; we were told ‘we have a chap come once a fortnight, he brings an electric piano and we have a sing song, we like that’. There is also a visiting hairdresser who visits the home regularly for those who require. The home have endeavoured to meet the spiritual needs of those who use the service. One user of the service takes Holy Communion in her bedroom and has a Catholic visitor from the church visit regularly. The home have contacted the local church to seek the possibility of the provision of a regular service within the home although this has proved difficult, however we are assured that the home will support residents to access the local churches and attend services when required. The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 19 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): 16 and 18 Quality in this outcome area is adequate. If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and documented with any action taken to put things right. Staff are aware of their responsibility to report any allegation or suspicion of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information about the complaints procedure is given to service users on admission. The complaints procedure is displayed within the home and copies are also available on request from the manager. The timescale for dealing with complaints is 28-days, as stated in the homes written procedure. We spoke to people residing in the home and all were confident that if they had a complaint, they would voice it and were confident that it would be attended to appropriately. Feedback from surveys we sent out also informs us that they are aware of the complaints procedure and confident that any complaints would be dealt with in a timely manner and appropriately. The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 20 Discussion with the manager and staff members informed the inspector that if there were any allegations of abuse these would be dealt with appropriately. There are policies and procedures in place for dealing with any allegations or incidences of this nature. We are informed that all staff working within the home are provided with training in safeguarding adults during their induction and know how to respond in the event of an alert, however the two staff files viewed failed to contain any documented evidence to suggest safeguarding had yet been covered during their induction. Likewise both these staff members were working, at times, unsupervised, without the service having received their full CRB disclosure deeming then safe to work with vulnerable adults. We were informed by one of the proprietors visiting the home that a safeguarding training session was being looked into and would be delivered to staff in the coming weeks, however there is no documented evidence to support this and a requirement has been made within this report to address this training issue. Discussions with staff members around safeguarding assured us that appropriate action would be taken in relation to suspicion of or an allegation of abuse. We are informed that there have been no complaints or safeguarding issues brought to the homes attention during the last 12 months. The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 21 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): 19, 22, 23 and 26 Quality in this outcome area is good. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides a physical environment which meets the specific needs of those using the service; it is comfortable and has a programme to improve the decoration and maintenance. The inspector toured the premises and, overall, found that all areas of the home were cleaned to a good standard with no unpleasant odours. The The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 22 residents’ private rooms were clean and individiualised with their own posessions and pictures in place. Residents spoken to on the day informed the inspector that they were happy with their rooms and found them to suit their needs. All rooms are provided with an en-suite facilities and a call system with an accessible alarm facility, which allows residents to call staff in the case of an emergency. People using the service and their visitors, have access to the outside gardens with seating arrangements provided. Generally the home provides an environment, which meets the service users needs, however it was noted, whilst touring the home, that a number of hazardous substances were being stored inappropriately in the second floor kitchenette area and in a cupboard in a hallway accessible to service users. A requirement has been made within this report to ensure that hazardous substances be stored securely at all times to ensure the health, safety and welfare of those using the service. Whilst touring the home we noted some areas of poor maintenance which need attending to which included some showerheads leaking, broken sash chords to some bedroom windows, a radiator cover not fixed appropriately to the wall and the need of a grab rail in one service users bedroom. One of the proprietors informs us that she visits the home on a monthly basis to identify any shortfalls regarding maintenance or health and safety and a note was seen in the office detailing some areas of maintenance that were to be dealt with, although during the last inspection undertaken in June 2007, the proprietors stated that they would ‘tour the building monthly to identify issues of maintenance and health safety hazards, which will be recorded, and a system for monitoring completion will be implemented’. Whilst we are informed that monthly visits are undertaken, there was no documented evidence available of these visits nor a system seen to be in place evidencing how these were being monitored. This should be attended to so as to ensure that environmental maintenance and faults are dealt with in a timely manner. The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 23 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): 27, 28, 29 and 30 Quality in this outcome area is poor. . The recruitment practices and the staffing levels between the hours of 9pm and 8am could seriously compromise the health, safety and welfare of those using the service. Staff are appointed and start working without important documentation being received to ensure their suitability to work with vulnerable adults. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has a poor recruitment procedure in which staff are appointed and start working without ensuring their suitability to work with vulnerable people which could potentially place those using the service at risk of harm. We are informed that The Lindens uses the services of a recruitment agency who specialise in finding candidates from overseas for vacancies in care homes, however the responsible person must ensure that he shall not employ a person to work at the care home until he has obtained all the necessary information and documentation as required by the Care Homes Regulations 2001. The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 24 One staff personnel file viewed evidenced that they began working at The Lindens in April 2008 and to date the work permit contained within their file was invalid. The file failed to contained an application form and did not evidence that the person had been interviewed for the position. Whilst the file contained an employment history there was no documented evidence explaining the evident gap between leaving full time education and beginning work - the registered person must ensure to gain a full employment history with any gaps documented. Although a POVA (protection of vulnerable adults) check had been undertaken and was documented within the said file, a full CRB (Criminal Records Bureau) Disclosure had not yet been received; there was a declaration within the said carers’ file stating that he/she is working under supervision until a CRB certificate is issued however the staff rota for night duty during the period from 9th June to 27th July 2008 evidenced that the said carer was rostered to work without any other staff member supervising or in fact working with him/her. Likewise, the signing in book, in which staff sign their time of arrival and time of departure evidenced this to be the case. The practice of leaving vulnerable people in the hands of staff without having gained a full CRB disclosure, deeming them fit to work with vulnerable adults places them at potential risk of harm. The staff induction and training record was only partly completed indicating that some aspects of the induction were completed 6 weeks after the commencement of employment at The Lindens yet there is no employee signature agreeing that they have undertaken parts nor that of the trainer signing off the competencies and therefore it is not possible to ascertain that an appropriate induction has been undertaken. The second staff file viewed indicated he/she was also employed in April 2008. Evidence within this file evidenced that similarly their full CRB disclosure had not yet been issued and a declaration was held in their file stating that they would be working under supervision until obtained. An employment history was documented detailing employment undertaken from 2004 however there is a gap of 23 years from which he/she left school and gained employment in 2004 and a further recent gap of 12 months both without any documented explanations for the gaps. The file contained two references although one of these were undated and neither were specifically addressed to either the recruitment agency or The Lindens. It was noted that whilst the said person had been employed in a similar care setting in 2007 as a care assistant, a reference had not been sought from this employer. Instead one reference was related to the persons last place of work which involved some private care work and another reference from a person for whom he/she had undertaken care work for their family member, although this is not documented on the employment history. There is no evidence of these references having been verified. A medical history document was found on file although this had not been completed and was left blank. As in the case of the first personnel file viewed, the staff induction and training record was only partly completed indicating that some aspects of the induction The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 25 were completed 6 weeks after the commencement of employment at The Lindens yet there is no employee signature agreeing that they have undertaken parts nor that of the trainer signing off the competencies and therefore it is not possible to ascertain that an appropriate induction has been undertaken. We viewed a long standing member of staffs file to satisfy ourselves that relevant training had been undertaken and an appropriate recruitment had been undertaken and all was well documented with no concerns. Upon discussion with this carer we were informed that he/she is registered to undertake the NVQ level 3 in care and that three staff are undertaking it, however information provided to us prior to the inspection informs us that seven of the twelve permanent staff have gained NVQ level2 in care and that no staff are working towards level 2 or above. The same carer informs us that they are all provided with yearly safeguarding training and that he/she has recently undertaken short courses in dementia care, infection control and healthy eating. We have concerns about the provision of staffing for the night shift. During our visit we noted that during the hours of 9pm and 8am only one member of staff was rostered to work during the night shift, thus being left in sole charge. The inspector asked to speak with the carer on duty the night of the inspection but this proved very difficult. The said carer did not understand what was being asked and made a telephone call on his/her mobile telephone to call a carer who lives on the premises to act as an interpreter. This is very concerning and raises questions as to whether the service users needs are being met appropriately when communication barriers are apparent. Upon further enquiry, it was ascertained that the carer had not received any medication training and was therefore unable to administer medication to those service users who were prescribed medication on an ‘as required’ basis. Upon further discussion with the said carer, through the interpreter, it was evident that he/she was not familiar with the emergency procedures should there be a fire at the home. An immediate requirement was made to address these issues and we received confirmation from the registered responsible person that action had been taken to ensure that 2 established (long standing) staff will be supporting the residents from 9pm to 8am and that these 2 staff have been inducted in the homes emergency procedures. The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 26 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): 31, 33, 35 and 38 Quality in this outcome area is poor. The service is failing to work in the service users best interests; it is not being effectively managed and monitored to safeguard service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has been without a registered permanent manager for seven months and we have not received an application to register a manager. There is an The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 27 acting manager in place who has the appropriate skills and experience to manage the service appropriately in the interim. We have serious concerns with how the home is managed during the night which does not act in the service users best interests and places them at risk of not having their need met in full. During our visit we found serious shortfalls around the staffing levels and competencies during the hours of 9pm and 8am in which only one member of staff was rostered to work during the night shift, thus being left in sole charge of 8 residents. Communication was also found to be problematic which is very concerning, appropriate medication had not been undertaken and therefore the carer unable to administer ‘as required’ medication if the need arose. These concerns raise questions as to whether the service users needs are being met in full during the night shift. (see section headed staffing). An immediate requirement was made to address these issues and we received confirmation from the registered responsible person that action had been undertaken to address these failings, that 2 long standing members of staff will be supporting residents during the night shift, both of whom have been inducted in the homes emergency procedures. A requirement was made at the last inspection for the registered person to undertake regular quality assurance visits in line with Regulation 26 of the Care Homes Regulations 2001. Following the inspection he said that he would commission the external consultancy that he has been working with to do this for him and agreed to confirm in writing to the Commission when the first three quality assurance visits have been undertaken and prepare a written report of the findings and the actions to be taken to improve the service. To date we have not received such a report. During this visit, we asked to view the monthly reports of the visits undertaken since our last inspection; there was no documentation held within the service to evidence that these visits are being undertaken on a regular monthly basis. Information provided to us in the AQAA informs us that a quality audit has been undertaken since the last inspection, however there was no documented evidence to support this. The recruitment procedures are not robust and fail to protect people using the service. Correspondence received from the registered responsible person in response to the recruitment findings during this visit is that The Lindens uses a reputable agency who are aware of the homes specific requirements. It is the responsibility of the registered person to ensure that a robust recruitment procedure is undertaken in line with the Care Homes Regulations 2001 for which a requirement has been made. The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 28 Findings from this visit evidence that the service is not working in the best interests of those using the service their health safety and welfare is being placed at potential risk. The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 29 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 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 x 18 2 2 x x 3 3 x x 3 STAFFING Standard No Score 27 1 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 x 3 x x 1 The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13 Requirement Ensure that all risk assessments and documents within care plans are completed and kept up to date and gain the service users’/representatives signature to evidence their involvement in the process. Ensure that a photograph is held on each service users file. Ensure that arrangements are in place for the safe storage of medications at all times, including those for returns. A system for identifying and monitoring any maintenance and health and safety standards must be put into practice. Previous timescale of 6/08/07 not met. The registered provider must undertake monthly quality assurance visits to the home and prepare a written report of the findings and the actions to be taken to improve the service. This requirement remains outstanding from the previous The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 31 Timescale for action 31/10/08 2 3 OP37 OP9 17(1)a Schedule3 13(2) 10/08/08 10/08/08 4 OP19 26 10/08/08 5 OP33 26 10/10/08 6 OP29 19 report. Previous timescales of 31/7/05, 01/10/06, 30/04/07 and 6/08/07 not met. Ensure a robust recruitment procedure is in place and that all necessary checks are obtained prior to a new member of staff commencing employment. The ratio of care staff to service users needs be determined according to the assessed needs of residents and a system operated for calculating staff numbers required, in accordance with guidance recommended by the Department of Health. 10/08/08 7 OP27 18(1)a 10/08/08 8 OP27 18 9 OP36 18(2) Ensure that at all times suitably 20/06/08 qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of those using the service. Ensure that staff are 20/06/08 appropriately supervised whilst awaiting their full CRB Ensure to register a permanent manager of the home with CSCI. Hazardous substances must be stored securely at all times to ensure the health, safety and welfare of those using the service. Ensure that CSCI is notified of any accidents/incidents as listed under regulation37 within 24 hours. 30/09/08 26/07/08 10 11 OP31 OP38 8 13(4) 12 OP37 37 10/08/08 The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 32 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 OP9 Good Practice Recommendations It is strongly recommended to consider more robust arrangements for the recording of staff who administer medication, as discussed with the manager. The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 The Lindens DS0000028059.V365607.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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