Care Home: Linden Court

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What the care home does well What has improved since the last inspection? What the care home could do better: CARE HOMES FOR OLDER PEOPLE Linden Court Church Walk Watton Norfolk IP25 6ET Lead Inspector Jenny Rose Unannounced Inspection 10th January 2008 09.45 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 Linden Court DS0000038862.V357526.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. Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Linden Court Address Church Walk Watton Norfolk IP25 6ET 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) 01953 881753 katrina.dixon@norfolk.gov.uk www.norfolk.gov.uk Norfolk County Council-Community Care Katrina Elizabeth Dixon Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home can accommodate up to 36 Older People not falling in any other category. The home can accommodate 6 people who have a diagnosis of dementia whose names appear in the Commission`s records. 7th June 2006 Date of last inspection Brief Description of the Service: Linden Court is a care home providing personal care and accommodation for up to 36 older people. It is a Local Authority Home situated in the town of Watton, close to local shops, church and other amenities. The home was opened in the mid 1960s and consists of a two-storey building with an additional two-storey extension. There is a shaft lift for service users and staff to gain access to the first floor as well as being able to make use of the main staircase if appropriate. Bedrooms at the home are of single occupancy and of various sizes. There are no rooms at the home that have ensuite facilities, though there are a number of toileting and bathing facilities that are near to the rooms and communal areas. The home has extensive gardens that are well maintained and accessible for the service users as well as a small courtyard that is accessible through the dining area. The fees charged as stated by the Manager on 10 May 2006 are £368.22 a week. Additional charges include newspapers and toiletries; hairdressing at £4 - £15 and Chiropody £10. Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care Services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgements for each outcome group. This was a key, unannounced Inspection carried out over two days. The first was one of 7 hours. The second was for a further period of an hour and a half on 14th January 2008. A partial tour of the premises was undertaken; care plans, staff files and records for regulation were examined. The Manager was available during the first day, but due to staff training and staff absence because of sickness, was covering a Care Co-ordinator’s role; a role she was again covering on the second day. Discussions took place in private with four residents, three members of staff on duty, two visitors, two healthcare professionals and several residents in passing. The Annual Quality Assurance Assessment (AQAA) had been returned to the Commission. Prior to the inspection fifteen comment cards were received from residents, 14 of which stated they were completed with staff support, 10 from relatives/friends and 5 from staff, all of which provided useful information and which is reflected in this Report. What the service does well: • • There are pleasant views of gardens from some areas of the Home. Residents and relatives speak of the staff team as being friendly and welcoming, although there is some concern about staff time constraints. There are good training opportunities for staff and career development appraisals. A needs assessment is normally undertaken prior to people being admitted to the Home in order to assess whether or not the Home can meet those needs. However, two recent admissions had taken place in emergencies during the Christmas period. Trial visits are offered before decisions are taken to live in the Home long term, as well as trying to ensure that a new resident has met at least one member of staff beforehand. • Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 Page 6 • Relatives and friends are able to visit whenever they wish and are made welcome. There are rooms designated for residents to see their visitors in private other than their bedrooms, as well as being able to stay overnight if necessary and a variety of other communal areas, which are clean and homely. The Home has a new restaurant style system for meals, hot/cold drinks, readily accessible. Fresh fruit and snacks are readily visible and available, in the new, attractively decorated and refurbished dining room. • What has improved since the last inspection? • • • • • • An AQAA has been completed together with an Annual Development Plan. Staff training has taken place in the use of the Malnutrition Universal Screening Tool (MUST). The dining room has been attractively decorated and refurbished to the residents’ choice of colour scheme. Locks have been fitted to all bedroom doors for increased privacy. A new ‘restaurant’ style system for a flexible meals service has been introduced. A number of areas of the Home have been redecorated and refurbished, which includes one communal sitting area, a number of bedrooms and in particular the dining room. The Home has the services of a maintenance person on a part time basis. Care staff are encouraged to undertake NVQ qualifications by agreeing to undertake such training as and when joining the staff team. There is a suggestions box situated in front hall next to the signing in book to allow for anonymous suggestions or concerns. • • What they could do better: • The Home still does not possess adequate bathing facilities. However, plans are in place to make improvements to these and to the toilet facilities by May 2008. The lift is too small and cannot safely accommodate wheel chair users, although this important facility is now part of a development plan to be considered in the financial year April 2008/09. DS0000038862.V357526.R01.S.doc Version 5.2 Page 7 • Linden Court • • There were some documents seen that were undated and some care plans were not signed by the respective resident. There is room for improvement in building upon and developing the details of personal life histories and interests with the resident’s permission, in conjunction with the activities programme in order to further improve the more person centred, holistic care currently provided. Consideration should be given to the appointment of a designated Activities Organiser to organise such an activities programme. In the months preceding the Inspection there had been staff shortages due to long term sickness, but the dependency levels of residents should continue to be monitored to determine staffing levels at all times, including during periods of staff training. Further detailed risk assessments should be put in place concerning specialist equipment brought into the Home from the Hospital, especially concerning risk of fire. The MUST information for every resident contained in two separate files should be cross-referenced from individual care plans. The maintenance of the front drive and car parking area should be considered in line with two relatives’ comment cards. All the relevant documentation regarding relief staff, already employed by the Local Authority as Home Support, should be included in their staff file in the Home. Questionnaires to Health Care Professionals visiting the Home should be included in the Quality Assurance analysis. A review with staff concerning the security arrangements should be considered, in view of the fact that the Inspector was able to enter the Home on the first day of the Inspection unchallenged by staff. • • • • • • • • 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. Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 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 Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. It is the policy that people seeking to live in the Home have their individual needs assessed before admission to ensure that these can be met within the Home. The Home does not offer intermediate care but does offer respite care. EVIDENCE: Eleven residents’ comment cards stated that they had received sufficient information before entering the Home, together with a further two residents spoken with. One of these residents had attended the Home for day care before being admitted on a long-term basis. However, three comment cards said that they did not feel they had received sufficient information, although one person stated that the admission had been in an emergency, but added there were “no complaints so far”. Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 Page 10 The Manager confirmed that the last two admissions had been in emergency situations over the Christmas period, but it was not the Home’s policy and that needs assessments had taken place on admission and these assessments formed the basis of the care plans. One resident who was admitted in an emergency was about to return home and the other resident said she was on the point of deciding whether to stay. Another pre-assessment showed information from placing Social Workers and other Social Care Professionals and that a visit from a senior staff member had taken place. A review is held after 4 weeks. The Manager also confirmed the information contained in the AQAA that the Home was working towards the system where the member of staff carrying out the assessment is on duty when the resident is admitted. A fact sheet regarding the Home was being produced for prospective residents. Where possible two staff members will undertake the pre-assessment and prospective residents/relatives/friends are encouraged to visit the Home beforehand. The Home is no longer operating outside its conditions of Registration. No resident with a diagnosis of dementia are admitted to the Home; however, there is a variation to the conditions where it is proven the Home can meet the needs of named residents with a dementia already living in the Home. The Home does not offer intermediate care, but does offer respite care. Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. People living in the Home are satisfied with the delivery of their health and personal care, as well as respect for their privacy and dignity. EVIDENCE: Four care plans were examined, each containing a photograph of the respective resident and two of these residents were spoken with. The plans contained a social history (see Daily Living) as well as an individual assessment of needs and three of the care plans were signed by the residents. However, one of the short-term care plans was not signed and there is a recommendation for this. The care plans were seen to be reviewed regularly and the residents spoken with felt their needs were met. However, there was one care plan, which was missing the date on which the resident had been admitted, and there is a recommendation regarding this. Comment cards overall were positive concerning the standard of care received. Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 Page 12 Two senior members of staff are the link people in the Home for those staff working with the Malnutrition Universal Screening Tool (MUST). There are more frequent reviews for residents considered more likely to be at risk and fortified meals and dietary supplements are provided where appropriate. However, the MUST information, which is well organised and reviewed for all residents is kept separately from the care plans and there is a recommendation that this information is cross referenced to the care plans, especially to assist new or temporary staff. A record of falls and risk assessments were in place in all care plans examined. A further risk assessment became necessary in regard to specialist equipment used by one resident who had a visit from the Respiratory Nurse at the time of the Inspection. There is, therefore, a recommendation in the case of this particular risk where naked flame is involved (i.e. birthday cake candles). The District Nurse visited twice on the first day of the Inspection and confirmed that she visits regularly on an ‘as and when’ basis. She spoke of good communication with the staff and there were good records of medical visits and other healthcare professionals who are involved where necessary. The lunchtime medication round was observed. The medication records were seen to be well recorded and contained a photograph of each resident. The medications are now dispensed at a time convenient for the residents who have the choice of flexible meal times. There is a daily sheet for recording a four hourly gap between medications for each resident and another daily sheet for double-checking administration of medications. The Care Coordinator administering the medication on the day of the inspection spoke of the good relationship which exists with the Pharmacy and the GP Surgery, a member of which visits weekly, as well as on an ‘as required’ basis. The medication is stored in a properly equipped medication room with air conditioning. Controlled drugs are appropriately stored and recorded. A random sample was seen to be correct and there were risk assessments seen to be in place for those residents who choose to administer their own medication. The staff administering medications receive training. Staff were observed treating residents respectfully and speaking in a kind and patient manner. Two residents spoken to said they had choice in where they spent their days and where they ate their meals. On a tour of the building a number of ‘hotel-type’ privacy notices were seen to be used on residents’ doors. Some residents have their own telephones in their rooms and one resident has a mobile phone. A requirement from the previous inspection has now been complied with and all bedroom doors are now fitted with suitable locks to increase privacy for residents. Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 Page 13 Residents’ Comment Cards • “I couldn’t wish for anything better, it’s home from home.” Friends’ and Relatives’ Comment Cards • “We’ve been pleased with what we’ve seen of the quality of care provided. In particular, the courtesy and kindness with which the residents are treated.” • “Superb!” Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 Page 14 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. This judgement has been made using available evidence including a visit to this service. People living in the Home have choice in their lifestyle, including well-balanced meals served in a “restaurant” style of service. EVIDENCE: There are various areas for sitting and quiet areas for entertaining visitors in private, which are appreciated by residents and their visitors. The local nature of the Home means that some residents know each other as well as staff and visitors. On the first day of Inspection there were numerous visitors to the Home There is evidence from the Minutes of the residents’ meetings that social activities and meals are discussed. There are regular services of Worship. Visitors are encouraged to take meals with residents. TVs videos and DVDs are available in a number of areas of the Home. Manicures are available, which were appreciated by one resident spoken with; entertainers visit the Home. Extend exercise sessions take place on a regular basis and there was evidence of residents’ art and craft work to be seen displayed around the Home. One of the Care Co-ordinators takes responsibility for programming activities, which staff carry out. However, the AQAA states that staff input for Activities is limited due to pressure of work. Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 Page 15 There is a recommendation that consideration should be given to designating an Activities Organiser in order to develop a programme in line with the needs, wishes, interests and life histories of the people living in the Home, the latter being particularly important, given that the Home is caring for residents with a diagnosis of dementia. In addition there is a recommendation that the role of the keyworker be reviewed in order to gather further information (with the resident’s permission) on interests, hobbies and life histories. Two visitors were spoken with on the first day of the Inspection. They both, together with several relatives’ comment cards, confirmed that visitors were welcomed into the Home at any time. Residents and visitors spoken with commented favourably on the range of various choices open to residents. For example, residents said they could get up when they liked and there were some residents in the dining room at about 10.00am taking breakfast on the morning of the Inspection; others like to have breakfast in their room and stay in bed until later in the morning. Residents can choose to take their meals in the attractively decorated, light dining room, or in their own room. Residents chose the colour scheme for the refurbishment of the dining room. The system for serving meals has been changed to make it more flexible and for residents to be able to take their meals when they wish within a certain time period. An individual menu is displayed on each table and a fruit bowl, coffee/tea and water dispensers are readily available for those able to help themselves. There is a display fridge containing sweet and savoury snacks, which are always available and the food is displayed attractively on the servery and looked appetising. All the care staff have undergone MUST training and this “restaurant” style project is the subject of ongoing UEA research into its effect on the nutrition and health of the residents. Residents’ Comments: • “It’s like Home from Home”. • “More singing please”. • Relatives’ and Friends Comments: • “The staff are always friendly and welcoming and Linden Court has a lovely ‘homely’ feeling not always found in other care homes”. • “More out-sourced entertainment? i.e. Artistic (music) Religious Activity”. Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. People living in the Home feel that complaints and concerns are listened to and acted upon and that the Home’s policies and procedures help ensure that residents are safeguarded. EVIDENCE: All comment cards and the residents spoken with were aware of how to make a complaint; one resident said that he had aired his views on an issue, which had been dealt with to his satisfaction. The Home has a clear policy and procedure for dealing with complaints and a record is kept. In addition, since the last inspection there is a suggestion box in the front entrance porch, which would allow for any anonymous complaints/suggestions to be made. From the complaints book six complaints were seen to have been dealt with appropriately and in a timely manner. The AQAA states that it is intended to bring up complaints at staff meetings and to discuss suggestions for improvement. From examination of training records and speaking with staff it was evident that staff had received training in recognising the signs and symptoms of abuse. The residents spoken to felt they were well treated by staff. (There is a recommendation regarding security – see Management and Administration). Relatives’ Comment Cards • “I have never raised any concerns. My mother seems happy and likes the staff and the quality of food she is given.” Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this Service. The home is kept clean so that people living in the Home have a safe and well maintained environment in which to live, but there are insufficient bathrooms and unsuitable toilet facilities. There are plans to improve this situation during 2008. EVIDENCE: There are varied facilities available to the residents, which include several small sitting areas in addition to larger communal areas, which are appreciated by those residents and visitors spoken with. There is a hairdressing room, a thrift shop, a residents ‘shop’ from which to purchase sweets and toiletries. There are also pleasant views of the garden from some areas of the Home. Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 Page 18 Redecoration and refurbishment has taken place since the last inspection in one lounge and the Dining Room, where the décor was chosen by the residents. Bedrooms are being decorated as they become vacant, as well as other areas of the Home, as part of a rolling programme. Since the last inspection bedroom doors have now all been fitted with suitable locks. Residents’ rooms seen were furnished comfortably with resident’s belongings and plants on windowsills, if they wish and one resident has brought her own bed. Most bedroom doors display a personalised picture of the resident’s choice to signify who occupies the room. Many residents who need specialist equipment are occupying larger rooms and electrical sockets have been installed to accommodate this equipment, as well as for TVs and radios. However, there are only two assisted bathrooms being used, one situated on the ground floor and one on the first, which is poor. Plans are in place to carry out the improvements on two other bathrooms, together with toilets. Tenders for this work should be received by the end of February and the work completed by 16 May 2008. The requirement for this work to be completed still remains. The passenger lift is not large enough to accommodate a resident in a wheelchair with a member of staff to travel safely between floors. Although plans are in place for this deficiency to be addressed in the next financial year, (i.e. April 2008/09), the requirement for this work to be carried out remains, as well as the requirement for the continuing work in improving facilities and those areas where decoration is ‘tired’ and where there are paintwork scuffs from wheelchairs. There were some relatives’ comments regarding the state of the front drive and the difficulties of car parking on some occasions; there is, therefore, a recommendation for attention to be given to these matters. It is noted from the Regulation 26 visit of the County Council on 27 September 2007 that there was the following recommendation: “Although it is not a requirement to have window restraints on the ground floor windows and the risk to residents falling out is minimal, it would be good practice to risk assess this.” On the days of Inspection the Home was clean and tidy, no unpleasant odours and staff have received training in infection control, which was a recommendation from a previous inspection. Relatives’ and Friends’ Comment Cards: How do you think the Home can improve?: • Some rooms are in need of refurbishment. Recent decoration of dining room and change of meals a real improvement.” • “Putting ensuites into each room; not having to use commodes.” Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 Page 19 • • • • “Commodes in rooms is very outdated and unpleasant for residents and staff. A target date to replace these with proper facilities would be appreciated by all.” “Home needs a bigger lift and a wet room. Poor wheelchair access through the main entrance.” “Front drive badly needs some maintenance, tarmac cracked and breaking up.” High standard of personal care and cleanliness around the Home.” Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this Service. People living in the Home are satisfied with the delivery of their care, but addressing issues of long term sickness and faster filling of vacant posts would further improve the service for residents. EVIDENCE: The comment cards, visitors and residents spoken with were complimentary about the care delivered by the staff team. Members of staff spoken with were enthusiastic about their work, although they would like more time to be spent one-to-one with residents. Observation provided evidence that staff worked with residents in a caring and respectful way, promoting individual’s dignity and choice. On the first day of the Inspection the Manager was covering a Care Coordinator’s role, because of the absence of senior staff to ‘step up’ as they were receiving Dementia training. A Care Assistant had called in sick at short notice on the first day and no cover was immediately available. On the second day, the Manager was covering the Care Co-ordinator’s role. At the time of the Inspection a Senior Carer’s post was being advertised and two members of staff were absent on long-term sickness leave. No agency staff were being employed, but there were two relief posts being covered by County Council Home Support Staff. Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 Page 21 Although the issues of staff long term sickness and the senior vacancy were being addressed and staff rotas have been altered to cover busier times of the day, there is a requirement that the dependency levels of residents continue to be monitored in order to determine satisfactory staffing levels and sufficient cover is provided even at times of staff training. The Manager confirmed the information contained in the AQAA that there are now over 50 of the staff team who have achieved NVQ2 qualifications, in addition to a Care Co-ordinator who has an NVQ4 in care. From examination of files all staff complete Induction training and all are offered various additional training opportunities, such as training in Diabetes and MUST training and training in Dementia. Newly recruited members of staff now need to agree to undertake an NVQ2 qualification before starting employment. The documents and information needed prior to making staff appointments were seen to be in place for permanent staff, but there is a requirement that the relevant CRB reference information is contained in the staff files of County Council Home Support staff who are covering relief shifts. According to the residents and staff spoken to there is a keyworker system which residents say works well. Two members of staff spoken to said they enjoyed this designated relationship and looking after individual residents’ needs. From the files and staff spoken with it is evident that staff receive regular supervision and appraisals. There are regular staff meetings which members of staff said they found helpful. Staff also confirmed that there was time at the beginning and end of shifts which enables them to carry out their work in a competent manner. There was one staff comment card which spoke of low staff morale during the previous year. However, the Manager was of the opinion that this was possibly also related to events unrelated to the running of the Home and were being addressed by the involvement of the Occupational Health team and proposed “Well Being” seminars for staff. Relatives’ and Friends’ comment cards: • “Friendly staff who treat residents with respect.” • “(They) treat each person with respect and look after their individual needs.” • “They are all very caring people and encourage my mother to live independently but are there when needed.” • “My mother is upstairs. When visiting sometimes I do not see a member of staff, only the cleaner.” • Staff comment cards: • “At this present time we always seem to be short of staff.” • “Lots of sickness at present.” • “Due to long term sickness and staff leaving, short staffed.” Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 Page 22 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): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager and the staff team work hard to ensure people living in the Home receive a good standard of care. EVIDENCE: The Manager has been in post since the last inspection, although she had previously managed another Local Authority Home for some years and has much experience in residential care. She has gained the Registered Manager’s Award and is awaiting the results of the NVQ level 4 in care. She has recently been developing her own knowledge of Dementia Care and Dementia Mapping. She is assisted by a part-time Administrator who possesses many years’ experience of working for the Local Authority. Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 Page 23 The Local Authority monitor the quality of the Service, which includes questionnaires to residents, their relatives and other interested parties. There is an Annual Development Plan in place and the Manager has also completed the AQAA. The Manager has yet to formally publish the results of the quality assurance survey, but the results seen indicated that residents regarded their care as being of high quality: their relatives deemed the care to be of good quality and the staff felt that the care delivered was adequate. The Manager said that any issues raised as a result of these surveys were discussed at regular residents and staff meetings, the Minutes of which were both seen. Regular Regulation 26 visits take place by the Local Authority; copies of these reports are sent to the Commission. Although the Manager reported that opinions are sought from visiting Healthcare Professionals, there is a recommendation that these results should also be formally analysed. The financial records and a sample of monies held on behalf of three residents were examined; all were seen to be well kept and correct. The Administrator audits these records weekly. Training is given to all members of staff in respect of Moving and Handling, Food Hygiene, First Aid, Fire Safety and Infection Control and this was confirmed by the information in staff files and from speaking to members of staff. Accidents and Incidents are recorded and audited and Regulation 37 forms are completed as appropriate and copies sent to the Commission. Fire Alarms are tested weekly and Legionella tests undertaken on a regular basis by the Maintenance person. There is a recommendation that a review of security arrangements be undertaken with staff in view of the fact that even though there is an electronic keypad on the front door, the Inspector was able to enter the Home on the first day of the Inspection without being challenged by staff, Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 Page 24 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 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 Page 25 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 OP22 Regulation 23 (2)(n) Requirement The passenger lift is not large enough to carry a wheelchair plus a member of staff safely. Work should commence April 2008/09 according to plan. The plan of improvement of those areas of the home, which are tired, should be continued this would ensure that there is a more pleasant environment for people living in the Home. The plan for two more improved bathrooms and toilets should be carried out in order to provide better bathing facilities for people living in the Home. Staffing ratios should continue to be determined according to the assessed needs of residents, to ensure that the needs of the people living in the Home come first. (This refers to covering training as well as filling vacancies) Timescale for action 05/04/08 2. OP19 23 (2)(d) 05/04/08 3. OP21 23 (2)(j) 16/05/08 4. OP27 18(a) 20/01/08 Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 Page 26 5. OP29 Schedule 2 All staff files should contain the necessary recruitment information to further ensure the safety of residents. (This refers to relief staff already employed by the County Council) 31/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP7 OP7 OP7 OP7 OP13 Good Practice Recommendations It is recommended that care is taken to enter the date on records in order to comply with best practice It is recommended that every resident and/or relative signs their care plan in order to comply with best practice. It is recommended that the MUST information is crossreferenced to the care plans to assist new or temporary staff to meet the nutritional needs of residents. It is recommended that a risk assessment be in place with particular reference to the use of an oxygen cylinder in the vicinity of a naked flame (i.e. birthday cake candles). Consideration should be given to reviewing the role of the keyworker to ensure that people living in the Home can be sure that their needs, choices and rights are known. (In this case to gather information, with the resident’s permission concerning interests and life histories). Consideration should be given to appointing a designated Activities Organiser to develop the present activities programme in line with the needs, wishes, interests and life histories of the people living in the Home. Consideration should be given to improving the state of the front drive and car parking issues to provide safer access by visitors to the Home. It is recommended that opinions be sought from Healthcare Professionals and formally analysed in the Quality Assurance system in order to further monitor the quality of the care in the Home. It is recommended that a review of security arrangements be undertaken with staff to further ensure the safety of the people living in the Home. 6. OP14 7. 8. OP19 OP33 9. OP38 Linden Court DS0000038862.V357526.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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. 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