Care Home: Linden House

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What the care home does well One of the residents indicated that he was happy living in the home, saying "nice home". The staff are friendly and work hard to meet the significant support needs of the residents. Staff at the home work hard to meet the very complex needs of people living there, including people`s severe communication difficulties. They have access to a range of health and social care professionals to assist them in this work. The home supports and encourages people living there to make a range of informed choices about their day-to-day lives to the extent to which they are able.People living at the home come from a range of differing cultural backgrounds and the home continues to help them understand and celebrate these. The home is commended for practice in this area. There is a high standard of staff training and support provided by management to ensure that they work with people in line with best practice. People living at the home are supported to have holidays away from the home, including support for one person to travel abroad to see family members. Family members are encouraged to be involved in the home, with meetings held regularly, in addition to informal parties to which they are invited. What has improved since the last inspection? Safe systems were put in place for the administration of medication to people living at the home. The kitchen had been cleaned thoroughly, and a high standard of cleanliness had been maintained since the previous inspection. Blinds had been provided for the ground floor windows, although some of these were already broken by the time of the current visit. A planned redecoration programme had been recorded for the building, and some work on redecoration had commenced and additional dining room chairs and tables had been purchased for the home. The garden area was being maintained with a herb and sensory area, vegetable area, shady areas with seating, and a lawn for playing ball games. What the care home could do better: A clearly recorded agreement must be in place for a restriction to the rights of a person living at the home, and better recording of healthcare appointments offered to or attended by residents should be put in place, to ensure that people`s health needs are met. The leak in a bathroom must be fully addressed so that people can use this bathroom and the sensory room beneath it once again. The area behind the tumble dryers must be kept clear from dust, and some identified repairs and redecoration in people`s rooms and the home`s corridors, is needed for the comfort and safety of people living and working at the home. Staff files must contain all relevant employment information to evidence that people are protected by rigorous recruitment procedures.The home`s water storage system must be checked annually, and some improvements are needed in fire safety procedures for the home for the safety of people living and working at the home. It is recommended that there be more detailed records kept of support provided to people outside of the home, and that advocacy services be obtained for people using the service as needed. Greater access to a vehicle would benefit people living at the home. The possibility of having a pet at the home, should be considered in line with people`s choices, and higher quality blinds should be made available for the home so that people`s privacy is better protected. CARE HOME ADULTS 18-65 Linden House 10 Linden Road Tottenham London N15 3QB Lead Inspector Susan Shamash Unannounced Inspection 22nd – 28th July 2008 11:30 Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Linden House Address 10 Linden Road Tottenham London N15 3QB 020 8888 0565 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) norayahmet@haringey.gov.uk London Borough of Haringey Manager post vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th July 2007 Brief Description of the Service: The home is owned and managed by London Borough of Haringey Social Services Department and is registered to accommodate six younger adults with a learning disability. The home currently accommodates people with complex needs and behaviour that can challenge services. The home is an adapted three-storey house with the entrance and most of the ground floor being fully accessible. The ground floor consists of two communal lounges, kitchen, dining room and a toilet/ bathroom, a separate toilet and staff facilities. The first floor, which is not accessible to wheelchair users, contains six residents bedrooms, a visitor’s room and further toilet, bath and shower facilities. The second floor is kept locked and used for storage, it is not used by people living at the home. The home is situated in a pleasant residential area of Haringey and is within walking distance of a range of local shops, pubs, restaurants, transport facilities and the other multicultural amenities of nearby Wood Green. The home is currently only used by people that are the responsibility of the London Borough of Haringey and the unit cost of a placement could not be ascertained at this inspection. The manager stated that a range of information about the service is shared with people living there and other stakeholders either individually, at meetings and on request. A copy of the latest CSCI inspection report is displayed in the home’s entrance hall. The stated aim of the service is to take a creative and diverse approach to the care and support offered to people living there and to promote their participation in all aspects of their daily lives. The home’s statement of purpose goes on to say that the home works in close partnership with service users to actively promote participation in everyday experiences, opportunities and decision-making. Linden House DS0000033209.V368467.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 2 star. This means the people who use this service experience good quality outcomes. This unannounced key inspection took approximately twelve hours over two days, including an evening visit until approximately 7.30 pm. There were six people living at the home at the time of the inspection (no vacancies). Noray Ahmet, the manager had not long returned to work followed a long period of sick leave during which management cover had been obtained for the home. The home had admitted one new person since the last inspection. This unannounced inspection took place over approximately seven hours. I was assisted by an ‘expert by experience’, accompanied by their support worker, for part of the inspection. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The majority of people living at the home have very high communication needs. The expert by experience was able to talk to one resident who was present independently, and others with staff support in addition to three support workers. The expert by experience looked at choices, quality of life and staff interactions with the residents. I spoke with three residents and four staff members during the visits. Further information was obtained from a tour of the premises and documentation kept at the home. What the service does well: One of the residents indicated that he was happy living in the home, saying “nice home”. The staff are friendly and work hard to meet the significant support needs of the residents. Staff at the home work hard to meet the very complex needs of people living there, including people’s severe communication difficulties. They have access to a range of health and social care professionals to assist them in this work. The home supports and encourages people living there to make a range of informed choices about their day-to-day lives to the extent to which they are able. Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 6 People living at the home come from a range of differing cultural backgrounds and the home continues to help them understand and celebrate these. The home is commended for practice in this area. There is a high standard of staff training and support provided by management to ensure that they work with people in line with best practice. People living at the home are supported to have holidays away from the home, including support for one person to travel abroad to see family members. Family members are encouraged to be involved in the home, with meetings held regularly, in addition to informal parties to which they are invited. What has improved since the last inspection? What they could do better: A clearly recorded agreement must be in place for a restriction to the rights of a person living at the home, and better recording of healthcare appointments offered to or attended by residents should be put in place, to ensure that people’s health needs are met. The leak in a bathroom must be fully addressed so that people can use this bathroom and the sensory room beneath it once again. The area behind the tumble dryers must be kept clear from dust, and some identified repairs and redecoration in people’s rooms and the home’s corridors, is needed for the comfort and safety of people living and working at the home. Staff files must contain all relevant employment information to evidence that people are protected by rigorous recruitment procedures. Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 7 The home’s water storage system must be checked annually, and some improvements are needed in fire safety procedures for the home for the safety of people living and working at the home. It is recommended that there be more detailed records kept of support provided to people outside of the home, and that advocacy services be obtained for people using the service as needed. Greater access to a vehicle would benefit people living at the home. The possibility of having a pet at the home, should be considered in line with people’s choices, and higher quality blinds should be made available for the home so that people’s privacy is better protected. 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 House DS0000033209.V368467.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 2. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The needs of people referred to the home are assessed to ensure that the home can meet their needs. Once admitted people’s needs continue to be reviewed so that their changing needs can be met. EVIDENCE: Evidence was seen on the most recently admitted person’s file, of a range of up to date assessment information that was available to the home before their admission to the home. The manager explained how the admission process worked including staff visiting the person in their previous placement and the person visiting the home before admission. The home has produced photographs of the building and people living there undertaking a range of activities. This is used to supplement other information about the home, to assist people who are nonverbal or have other communication needs, to have an insight into what living at the home may be like before they move in. The photograph album is available on a CD and the manager stated that this had been used very successfully during the admission process for the latest person. Inspection of the files of three other people showed that their needs were reviewed on a regular basis to ensure that changes were known to the home. Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 10 Assessments involved input from a range of health and social care professionals and evidence was seen of ongoing input from those professionals. Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments are kept up to date to ensure that staff are aware of people’s changing needs and how these should be addressed. Staff are working hard to assist people make as many decisions for themselves as they can about their day to day lives although further independent input is needed to ensure that people’s rights are respected as far as possible. EVIDENCE: I inspected five people’s care plans and risk assessments. Staff and the manager advised that training had been provided for staff on person centred planning. They also advised that goals for each person had been reviewed with the assistance of a psychologist and other relevant professionals, in addition to people’s relatives where appropriate. Each care plan had been reviewed within the last six-months, and all reviews and evaluations of people’s care plans were signed and dated by the person undertaking the review as appropriate. The care plans seen contained relevant Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 12 detail and were informed by up to date assessment information, including risk assessments. The home operates a key worker system with evidence seen that key workers are involved in reviewing the plans. Care plans were supplemented by more detailed guidance for staff where appropriate. These included personal care guidelines, controlling epilepsy guidelines and behaviour management guidelines. The care plans I inspected were clear and it was possible to determine the actions taken by staff to address the needs of people using the service. All of the five people living at the home at the time of the inspection had significant support needs regarding communication. Staff were working hard to assist people in communicating their wishes and to make decisions regarding their daily lives. One example of this was that the home has continued to develop a range of photographs of relevant objects to assist one person communicate their needs. The photographs are displayed on a board in the home and also contained in a book that staff can take out of the home with the person. The home continues to promote the use of makaton sign language to assist this process. A makaton sign chart was displayed in the home’s dining room with a designated “sign for the week” being displayed. All of the people living in the home have some limitations imposed on them relating to keeping them safe. Evidence was generally seen that these limitations were agreed and monitored through the assessment process and recorded in the person’s care plans. Each of the people’s files inspected contained up to date risk assessments. Staff spoken to were aware of identified risks and the current guidance on how to minimise these. During the inspection staff were observed implementing the guidance as described in both the risk assessments and in relevant behaviour management guidelines. However I was concerned that there was no current written agreement in place regarding the use of monitoring equipment for an identified service user at night. This should including signatures of relevant medical professionals, the person’s social worker and an advocate (or relative) and be reviewed regularly to ensure that their rights are respected as far as possible. The manager advised that some research had been carried out into the availability of advocates for people living in the home. However no advocacy service was yet working with any person living at the home. It is recommended that this area be further pursued to establish advocacy services for people living at the home. Daily records were being recorded for each person, including information about support provided to them within and outside of the home. It is recommended that records should include more information about support provided to people Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 13 outside of the home rather than simply recording ‘supported in the community’ to evidence actual support provided to individuals. Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home have access to a range of resources to assist them to participate in appropriate activities at home and within the local community. They also benefit from clear efforts being made to assist them relate to their cultural origins. Contact with relatives is promoted and encouraged, so that people benefit from these important relationships. Their rights are responsibilities are respected and promoted within their daily lives. People also enjoy healthy and ethnically appropriate meals that meet their nutritional needs. EVIDENCE: Each of the people living at the home had a weekly programme of activities displayed in the dining room. Most of them attended external day service as part of their programme although the number of days they attended varied. People were attending the day services as shown on their programme during the inspection. A range of other activities was also shown for each person and these were undertaken both in the home and in the local community. These Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 15 were mainly individual activities undertaken with staff support and included visiting a library, going to the pub, cinema, parks, a club on a Monday evening and one person attending a weekly trampoline session in a community setting. The expert by experience spoke to a number of staff and residents. The key worker of one of the residents, who is non-verbal, said that after noticing the persons love of music and movement, they started to take him regularly to the Monday club. Another key worker advised that another resident is very religious, spending hours in his room listening to Gospel music. Therefore, they are considering taking them to a regular Sunday Church service to meet their spiritual needs. The expert noted that the key workers seemed to know the residents they support well. The home continues to have and an additional dedicated 72 staff hours allocated to facilitate residents accessing the community. This is on a one-toone basis or with two staff accompanying one resident where this is necessary to support the person. The manager stated that the home was still able to access a minibus from the provider organisation (London Borough of Haringey) to assist in arranging other outings in the community and evidence of this was seen from documentation in the home and from staff spoken to. On the day of the inspection the home was preparing to hold a barbeque for people living at the home, their relatives, friends and other stakeholders. The manager and staff continue to promote and celebrate the cultural diversity of both people living in the home and of staff. There is a large world map in the dining room with stickers indicating the parts of the world where people who use the service, their families and staff originated. A staff member had undertaken a project to compile a CD that contained tracks of music representing the countries of origin of staff. This included music from Ghana, Cyprus, Albania, Kenya, Sierra Leone, the Caribbean and Nigeria. Residents are supported to have a choice of religious music in the home and where possible residents attend religious gatherings with their families. The manager also advised that the home celebrates a number of cultural events such as Black History month and a celebration barbeque at the home. The home was also planning a cultural day over the summer, to which guests would be invited to celebrate the different culture of people living and working at the home including different cultural foods, music and decorations. The majority of people living at the home have regular contact with relatives. This includes relatives visiting the home and people living there visiting and staying with relatives. People’s records showed evidence of discussion, information giving and seeking the views of relatives on a range of subjects relating to the home. A relative of one resident whose first language is not Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 16 English, visits three times a week, talking to them in their native language. The home is also commended for supporting a service user to visit their family members abroad for a holiday over consecutive years, despite the difficulties inherent in taking this person on a long haul flight and supporting them for several weeks in a foreign country. The service is also working to support the wishes of this resident who wishes to be with their family abroad on a permanent basis, and actively pursuing this option through the Direct payment model of support. Staff were seen to interact sensitively and appropriately with people living in the home including communicating with them using a combination of makaton signs and other means of verbal and non verbal communication. Staff indicated that insufficient availability of a vehicle to take people out in the local community, limited activities available to people, particularly at weekends and in the evenings. It is recommended that more use of a vehicle be made available for the home, due to the high needs of some people living at the home, who are unable to use public transport without a high level of support, so that people are able to go out more frequently. The expert by experience spoke to one person who liked cats. It is recommended that the possibility of having a pet at the home, such as a cat, be considered. The home continues to develop its menu to promote both healthy eating and an ethnically diverse range of meals. Evidence was seen of consultation with relatives about meals and the menu was seen to include dishes such as Jamaican Jerk chicken, Nigerian beef Jallof, lamb curry and Spaghetti Bolognese. Mechanisms had also been developed for giving people more options relating to meal times e.g. laying out choices of cereal for people to allow them to physically choose and help themselves to what they wanted for breakfast, thus giving them more autonomy in choosing. Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home receive appropriate personal support in accordance with their needs and preferences. The home works hard to address people’s mental and physical healthcare through referrals to a range of community based health professionals. A satisfactory system is in place for administering medication to meet people’s medication needs safely. EVIDENCE: All of the people accommodated have significant support needs regarding their personal care. Records in the home, discussion with staff and observations of interactions in the home indicated that serious efforts continue to be made to provide appropriate personal care in the way that people prefer. Each shift has at least one female member of care staff on duty to ensure that all people accommodated can access sensitive and gender specific personal care. Staff are also very aware of cultural considerations to take into account when addressing people’s needs. Evidence was seen that the physical and emotional health needs of people living in the home continue to be taken seriously. All people accommodated Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 18 are registered with a GP and are supported to attend a range of appointments with relevant healthcare professionals as required. Evidence was also seen that people living at the home have access to specialist healthcare professionals including psychiatrists, psychologists and speech and language therapists. The recording of attendance of these appointments, particularly routine healthcare visits, could be improved, so that these are more easily monitored to ensure that people are offered regular routine appointments including optical assessments. Where people refuse to attend such appointments this must be documented and risk assessments should be undertaken accordingly, to ensure that people’s health needs are met. Health care action plans had been compiled for each resident with consulation from local health care professionals. The manager advised that these documents are taken along to all healthcare appointments attended by people living at the home. In the Annual Quality Assurance Assessment for the service, the manager noted that the majority of the residents have high communication support needs, so with the assistance of parents/carers and speech and language therapists they had developed communication systems such as social stories, symbols, pictures and Makaton for more effective communication with residents. I inspected the medication storage arrangements and administration records. I was shown records of administration that were signed by two staff and that were audited weekly by senior staff. There were records of receipt of medicines into the home and appropriate storage arrangements were in place. Evidence was also seen that staff training in safe administration of medication was up to date. The medication and MAR charts for all residents were inspected. The majority of medication for people living in the home is supplied via a monitored dosage system (MDS). This is in the form of blister packs with each dose of medication being supplied for the appropriate time of day for each day of the month. The medication is supplied in four weekly packs marked for the appropriate day of the week. Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home and their relatives are able to express their views and concerns and have these appropriately addressed. People living at the home are also protected by satisfactory adult protection policies and procedures, that staff are aware of. EVIDENCE: A serious concern raised about the care of one of the people living in the home continues to be formally investigated by the local authority under their safeguarding adults (adult protection) procedures. The home had a satisfactory complaints procedure that was seen with a summary displayed in the entrance hall. The procedure gave the information required under this standard, including the details of CSCI. The procedure also states that complainants can use the London Borough of Haringey’s complaints procedure if they are not happy with the way the home has dealt with their complaint. The manager stated that apart from the concern referred to above no other concerns of complaints had been received at the home since the last inspection. The home had a satisfactory adult protection procedure that was seen. The home also had a copy of the local authority’s procedure. The manager stated that apart from the concern above that is being investigated by Haringey, no other allegations or disclosures of abuse have been received by the home. Evidence was also seen that staff training in adult protection was up to date Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 20 and staff spoken to were able to state what action needed to be taken should an allegation or disclosure of abuse be made to them. Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is generally comfortable and homely but their comfort is compromised by inadequate decoration, and maintenance. The home is generally clean and tidy, creating a satisfactory environment for those that live and work at the home. EVIDENCE: The home is an adapted three-storey house with the entrance and most of the ground floor being fully wheelchair accessible. The ground floor consists of two communal lounges, a kitchen, dining room and a toilet/bathroom, separate toilet and staff facilities. The first floor, contains six bedrooms, a visitor’s room and further toilet, bath and shower facilities. The second floor is kept locked and used for storage, it is not accessible to people living in the home. The home has a large enclosed rear garden within which a sensory garden has been constructed and this contains a range of elements including wind chimes, mirrored mobiles, a bird table with hanging feeders, raised plant beds and a Mediterranean style seating area. Staff spoken to and information, both written Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 22 and pictorial, displayed in the home showed that a vegetable area had also been provided in the garden. I saw two people enjoying the garden area, one was sitting outside in the shade, whilst the other was playing with a ball (with staff support). Staff members were busy preparing the garden for a barbeque party later in the week. There was a TV, DVD player, music centre and pictures and photos on the walls of the living room. There is a spacious dining room with two tables and many chairs. The kitchen was clean, and new chairs had been provided in the dining area since the previous inspection. However although there were parts of the home which were attractive, there were also parts, such as the staircase, corridors and some bedrooms, which were in need of redecoration. Some parts of the home were showing signs of wear and the sensory room was not operational due to leakage onto its ceiling from a bathroom above. The leak in the relevant bathroom must be fully addressed so that people can use this bathroom again, and the sensory room beneath it can be used once again, for the comfort and stimulation of people living at the home. At the last inspection a requirement was restated that the windows in the front ground floor rooms of the home have curtains or blinds fitted. The windows in question are close to the pavement and the interiors of the rooms are clearly visible from the pavement. Given the needs of the people living in the home it was important for blinds or curtains to be fitted to protect their dignity and privacy. New blinds had been fitted since the previous inspection, however although these were attractively coloured, they were not very strong, and therefore several of these were already broken. Because of this the majority of blinds were pulled back out of the way, leaving people in the rooms on the ground floor, clearly visible from the pavement outside. Due to the needs of people living at the home, it is recommended that higher quality (heavy duty) blinds be made available for the home so that people’s privacy is better protected. As required at the previous inspection, a cyclical programme for redecoration of all areas of the building had been produced. The building continues to receive very hard wear and tear due to the needs of the people living there. Although bedrooms including personal items, it is recommended that people be further supported to personalise their bedrooms, to increase their comfort. The vanity cabinet in an identified person’s room was in need of repair, one person’s bedroom was clearly overdue for repainting, and corridors, and radiator guards throughout the home appeared dirty, and in need of repainting for the comfort of people living at the home. The home continues to have satisfactory laundry facilities and infection control procedures, that staff are aware of. The home was appropriately clean and tidy Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 23 throughout during the inspection other than a build up of dust in the area behind the tumble dryers, and this must be addressed as it is a potential fire hazard. The extractor fan in an identified person’s room must also be cleaned for their safety and comfort. Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. A staff team with a range of qualifications and competencies, in sufficient numbers, support people living in the home. The home’s recruitment policy assists in protecting people living in the home. People are supported by staff who have access to appropriate training and formal supervision to assist them further in both meeting people’s needs in line with best practice. EVIDENCE: The expert by experience, and I, spoke to the manager and staff members working at the home. Staff were helpful and cooperative with the inspection and were happy to discuss their individual work with people using the service. There was a friendly, relaxed atmosphere at the home and we received a positive and welcoming reception. The home continues to make good progress with enabling permanent staff to achieve the national vocational qualification (NVQ) levels 2 & 3 in care. Evidence was obtained from some staff spoken to and from documentation seen, that team leaders have either achieved or are working towards NVQ level Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 25 3 in care. All other than the most newly recruited staff member have completed or are in the process of completing at least NVQ level 2 in care. The home continues to operate with one team leader and three support workers on both the early and late shifts. These staff are supplemented by an additional 72 hours agency staff per week to assist people living in the home to undertake programmed activities, including in the community. The manager’s hours are in addition to the above hours. Two waking night support staff and a sleeping-in team leader work at nights in the home. The home continues to use a high number of agency staff, including an agency team leader and a majority of agency support workers. The home only uses one approved agency to provide staff in accordance with Haringey’s policy on agency staff. Staff noted that the agency staff working at the home, did so on a regular basis so that they were very familiar with the needs of people living at the home. There were also clear induction procedures in place for agency staff, and they confirmed that they received a range of other up to date core training. Observation of interactions within the home indicated that it was difficult to differentiate between permanent and agency staff at the home. However staff did note that there was some disruption/distress caused to people living at the home due to the local authority’s policy of not allowing agency workers to continue working at the home for more than 12 months, for financial reasons. This has caused discontinuity for people living at the home, having built up trusting and supporting relationships with particular staff members. The home holds weekly staff meetings and records of these were seen. The manager had returned to work after an extended period on sick leave, and was very involved in working on team building, attending handover meetings when possible, and supporting staff as needed. Feedback received from staff was that they felt strongly supported by the manager. Five staff members’ files were inspected to ascertain whether the home operates a satisfactory recruitment procedure to maximise protection for people living at the home. One new permanent staff member had been recruited since the previous inspection. Although the majority of relevant information was available in each file, the references for an identified staff member were not available, and there was insufficient evidence that a relevant enhanced Criminal Records Bureau disclosure had been undertaken for this person. The manager advised that this was due to recruitment procedures within the local authority, whereby CRB disclosures are now no longer kept due to data protection issues. A requirement is made accordingly. The home’s training matrix alongside certificates found in staff files, provided evidence that permanent staff are up to date with training and refresher training in core subjects including: safeguarding adults (adult protection), first aid, health and safety, moving and handling, safe administration of medication Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 26 and food hygiene, although some staff members need further fire safety training. All staff had undertaken a 2-day communication skills course and several had undertaken advanced communication skills training. Some staff had undertaken Makaton training, and this was being promoted within the home. Records in staff files indicated that staff receive regular supervision and staff spoken to confirmed this. There was also evidence that annual appraisals were being undertaken for staff as appropriate. Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from effective management, but are disadvantaged by not having a registered manager in place with responsibility for the service. The home’s quality assurance systems contribute to the well being of people living there. Health and safety procedures generally protect people living at the home, although further work is needed to maximise protection in the event of a fire. EVIDENCE: The manager has both a social work and management qualification in addition to many years experience in working with vulnerable people and managing services. The manager was also very knowledgeable about the needs of the people living at the home. She is supported by 15 hours per week from an administrator. At the last inspection a requirement was made that the registered provider ensures that an application for registration is made to the Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 28 Commission in respect of the manager. However the manager had been on sick leave for an extended period following this inspection. This had therefore still not been complied with. However the manager advised that she would be submitting an application to the CSCI shortly (having only been back at work for a short time at the time of the inspection). As required previously, the manager is no longer the sole person on call for the home. The management structure within the home currently consists of a manager and four team leaders. Although team leaders have designated areas of responsibility including managing the shift when they are on duty there is no one person delegated to deputise for the manager in her absence. The home continues to accommodate people with a range of high needs, including communication needs, and managing the home is a complex and demanding task. It remains recommended that the management structure of the home be reviewed and consideration be given to creating a deputy manager post to assist the manager with management tasks and to assume delegated responsibility for the home when the manager is on leave. The home operates a key worker system and this is used as a mechanism for ascertaining the likes and dislikes of people living at the home to inform the care and support they are offered. The home also holds regular meetings for relatives to consult with them and minutes of these meetings were seen. The home has annual aims and objectives that relate and contribute to the local authority’s overall objectives. Regular monthly visits are also undertaken by a responsible individual on behalf of the provider organisation as appropriate. I looked at financial records for monies kept for safekeeping on behalf of two people living at the home. These were detailed and appeared to be accurate so that people are protected from financial abuse as appropriate. However the manager advised that the financial records for one of the people living at the home are currently kept by their appointee – a manager at one of the other care homes belonging to the local authority. It is recommended that these records and responsibility for this person’s finances be brought into home, so that this person is able to access their finances with greater ease. As required at the previous key inspection a current gas safety certificate, electrical installation certificate and portable appliances testing certificate were available for the home. However there was no evidence to document that the home’s water supply had been tested to minimise the risk of legionella in the past twelve months. A requirement is made accordingly. The home’s fire log showed that the fire extinguishers had been serviced in the past twelve months, that emergency lighting and the fire alarm system are regularly checked and that the home holds regular fire drills. However inspection of records for the weekly testing of fire alarm call points indicated Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 29 that the call points were being tested in a random order, which places some call points at risk of not being tested for a prolonged period of time. A requirement is made accordingly. The manager is aware that fire risk assessments must be reviewed at least six monthly, and advised that she was in the process of a major review of the process looking at each individual resident’s needs. There was evidence that fire doors were being tested weekly, but the provision of more magnetically held self-closing doors on the first floor of the home, should be considered, to avoid people wedging these doors open which presents a fire safety hazard. The majority of staff members had undertaken fire safety training within the last, eighteen months, but there is a need for the remaining staff to undertaken current training in this area for the safety of people living and working at the home. Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 3 X 3 2 X Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 31 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 YA9 Regulation 14(c) Requirement The registered person must ensure that there is a clearly recorded agreement regarding the use of monitoring equipment for an identified service user at night, including signatures of relevant medical professionals, the person’s social worker and an advocate, and that this is reviewed regularly to ensure that their rights are respected as far as possible. The registered person must ensure that healthcare appointments for each service user are monitored to ensure that people are offered regular routine appointments including optical assessments. Where people refuse to attend such appointments this must be documented and risk assessments should be undertaken accordingly, to ensure that people’s health needs are met. The registered person must ensure that the leak in the relevant bathroom is fully DS0000033209.V368467.R01.S.doc Timescale for action 26/09/08 2. YA19 12(1) 19/09/08 3. YA24 23(2cgj) 19/09/08 Linden House Version 5.2 Page 32 4. YA30 23(2d) addressed so that people can use this bathroom once more, and the sensory room beneath it can be used again, for the comfort and stimulation of people living at the home. This was partially addressed, but has since become a problem again since the previous inspection. The registered person must 12/09/08 ensure that the area behind the tumble dryers is kept clear from dust, The vanity cabinet in an identified person’s room is repaired, and The extractor fan in an identified person’s room is cleaned for the safety and comfort of people living at the home. The registered person must 12/12/08 ensure that an identified person’s bedroom is repainted, and corridors, and radiator guards throughout the home are cleaned or redecorated, for the comfort and safety of people living and working at the home. The registered person must 12/09/08 ensure that all relevant recruitment information is maintained in each staff member’s file at the home to evidence rigorous safeguards to protect people living at the home from harm. Copies of the references for an identified staff member, and evidence that relevant enhanced Criminal Records Bureau disclosures have been undertaken, must be sent to the CSCI. 5. YA30 23(2d) 6. YA34 17(2) Sched 4 Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 33 7. YA42 13(4) 8. YA42 23(4acd) The registered person must ensure that the home’s water storage system is checked annually by a person competent to do so, and that water systems are tested for Legionella, for the safety of people living and working at the home. Evidence of this must be sent to the CSCI. (Previous timescale of 15/02/08 not met). The manager advised that this had been undertaken, however no evidence of this was available within the home. The registered person must ensure that weekly testing of fire alarm call points is organised so that call points are tested in an agreed order, so that no call point is left untested for a prolonged period, The provision of more magnetic self-closing doors, should be considered in the corridors, and Remaining staff members must undertake current fire safety training, for the safety of people living and working at the home. 12/09/08 19/09/08 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. Refer to Standard YA6 Good Practice Recommendations It is recommended that records should include more information about support provided to people outside of the home rather than simply recording ‘supported in the community’ to evidence actual support provided to individuals. DS0000033209.V368467.R01.S.doc Version 5.2 Page 34 Linden House 2. YA7 3. YA13 4. 5. YA16 YA24 6. 7. YA37 YA41 It is recommended that further research be carried out to establish advocacy services that are available locally with the aim of offering advocates to people using the service as needed. It is recommended that more use of a vehicle be made available for the home, due to the high needs of some people living at the home, who are unable to use public transport without a high level of support, so that people are able to go out more frequently. It is recommended that the possibility of having a pet at the home, such as a cat, as suggested by one resident, be considered. It is recommended that higher quality (heavy duty) blinds be made available for the home so that people’s privacy is better protected, and that people be further supported to personalise their bedrooms, for their comfort. It is recommended that a deputy manager be appointed to support the manager at the home, so that effective management cover is provided at all times. It is recommended that the records of monies kept for safekeeping at another care home run by the provider organisation, on behalf of an identified service user, be brought into home. Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 36 Linden House DS0000033209.V368467.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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