Care Home: Linden House

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What the care home does well The home is spacious and homely and decorated and maintained to a good standard. The home has a core staff team that are motivated towards providing good quality care and support and relate well to the people living in the home. What has improved since the last inspection? No improvements since the previous inspection were identified. What the care home could do better: The service must ensure that a thorough admissions process is followed. The home must ensure that detailed care plans are drawn up that meet the needs identified in the assessments. The home must ensure that people living in the home have access to the healthcare professionals they require. People should have Health Action Plans in place. The home must ensure that all confidential material is securely stored. The home must ensure that staff training is accurately and correctly recorded. The home must implement a system of quality assurance. The home needs to have a period of stable management, leadership and consistency.Linden HouseDS0000069034.V377858.R01.S.docVersion 5.3 Key inspection report CARE HOME ADULTS 18-65 Linden House 205 Linden Road Gloucester GL1 5DU Lead Inspector Mr Simon Massey Key Unannounced Inspection 24th September 2009 10:00 Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Linden House Address 205 Linden Road Gloucester GL1 5DU 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) 01452 523700 01452 524555 info@carecommunity.co.uk Care Community Ltd Manager post vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning Disability (Code LD) The maximum number of service users who can be accommodated is 6. 2. Date of last inspection 18th September 2008 Brief Description of the Service: Linden House is a large detached property situated approximately two miles from the centre of Gloucester. To the rear of the house is a private garden where there is a separate building that has a living room and a laundry room. Two of the bedrooms are on the ground floor and the rest are upstairs, where the office is also situated. All have en-suite facilities. The home is situated in a residential area but is close to local amenities. The fees are negotiated on an individual basis depending on the needs of the individual service user. Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place on 24/09/09 and lasted for 7 hours. The Inspector met with the newly appointed Manager, the Provider, several members of staff and all of the people living in the home. Records relating to care planning, medication administration, staff recruitment and training, health and safety were examined. An inspection of the environment was also carried out. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service What the service does well: What has improved since the last inspection? What they could do better: The service must ensure that a thorough admissions process is followed. The home must ensure that detailed care plans are drawn up that meet the needs identified in the assessments. The home must ensure that people living in the home have access to the healthcare professionals they require. People should have Health Action Plans in place. The home must ensure that all confidential material is securely stored. The home must ensure that staff training is accurately and correctly recorded. The home must implement a system of quality assurance. The home needs to have a period of stable management, leadership and consistency. Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 6 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 7 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 DS0000069034.V377858.R01.S.doc Version 5.3 Page 8 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service must ensure that assessments are completed prior to admission and provide evidence that the needs can be met and that prospective admissions are within the registration category of the home. EVIDENCE: Two new people have moved into the home in recent months and the Inspector met with both. Both were pleased with how the placement was working out and positive about the staff and the accommodation. However a number of concerns were identified around the admission and assessment process for both people. There was a document completed by the then acting manager called the Preliminary Placement Assessment Report for each person. This was the only assessment material that was available. Both these documents contained very little information about needs and contained some statements that needed to be verified by other professionals but were not. It was also unclear whether the acting manager was suitably qualified to make these assessments. There were no placement plans, care plans or assessments in place from the placing authorities and also no background information such as personal care needs, family histories or diagnosis of needs or conditions. The paucity of information was poor and the suggested needs concerning, as these had Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 9 resulted in risk assessments that were restricting on the people living in the home. The Inspector was also concerned whether these new admissions were within the registration category of the home and a requirement has been made that this information is acquired from the placing authority and supplied to the Commission. The Commission have written to the placing authorities requesting information about assessments and the placing process but it is the responsibility of the home to ensure that professional detailed assessments are completed, and that people are not admitted to the services whose needs cannot be met, and who are outside of the registration category of the home. Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Basic care plans are in place but for some people the lack of comprehensive assessments and other information about needs compromises the effectiveness and relevance of these plans. EVIDENCE: The home has care plans in place which are being developed for the people living in the home. Pen pictures and “life plans” are in place for some people and being developed for others. However, due to the lack of proper assessments, the plans for the recent admissions to the home appear to be lacking in detail and are neither particularly person centred or goal orientated. Work needs to be completed by the staff team in conjunction with the people living in the home to develop care plans that are centred around their needs and aspirations and that people are fully involved in planning and reviewing their care and support. Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 11 People explained how they were consulted about their daily activities and were able to make choices and decisions in as far as their risk assessments allowed. One person stated they were happy with the restrictions in place and understood the reasons for these. There were a number of risk assessments in place and these were correctly reviewed and gave clear guidance for staff, however the Commission is concerned about the quality of the assessments these were based upon and the lack of substantive and detailed information in the individual files. The individual files and other personal information were being stored in an annex in the rear garden. This was generally not locked and neither were the cabinets holding the files. The home needs to ensure that all personal and confidential information is securely stored but is accessible to the care staff and to people living in the home if they wish to see it. Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 12 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): This is what people staying in this care home experience: 12, 13, 15, 16 & 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are given opportunities to take part in a variety of activities in the community but greater variety and choice could be provided once assessments and more detailed care plans are completed. Service users would also benefit from a more structured approach towards the development of independence skills. EVIDENCE: People spoken to expressed satisfaction with the day time and evening activities they were supported to undertake. The home were still in the process of planning and developing some opportunities for the people most recently admitted. People are given choices and the chance to pursue their interests. People are supported to maintain contact with families and friends when they wish to. Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 13 At times there have been some limitations on some choices for activities and outings due to the needs of one person, who has now left home, who required additional staffing at times to meet their needs. People spoken to said they were given choice in their routines and were consulted on all aspects of their activities. People were very positive about the food and said it was of good quality and that they were provided with choice and a healthy diet. All food was correctly stored and the kitchen was well stocked with fresh and frozen produce at the time of time of this visit. People can get involved in the menu planning and the cooking but this is on an informal and unstructured basis. Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, & 20 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples basic health and personal care needs are being met but assessments need to be completed to ensure the full range of emotional, support and care needs are being met. EVIDENCE: Any personal care needs are recorded in the individual files and staff spoken with were clear about the need to respect privacy and dignity when delivering this care. Two people living in the home had references made to medical conditions in their placement assessments, the quality of which was criticised in the Choice of Home standards. The personal files contain very little, if any, information on some of these medical and health issues and also no guidance to staff on any particular needs that have to be met or how this should be done. It would also seem that two people, if the assessments were accurate require some form of specialist professional input, and that the staff would also benefit form support and guidance, but it was unclear how and if they would be Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 15 organised. When the home receives, or completes, the detailed assessments of need it must establish how any specialist services are going to be accessed. All people need to have Health Action Plans developed. The medication storage and administration were examined and found to be in order. Staff do not administer medication unless they have completed the required training. Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are provided with a safe environment in which they are protected and able to raise concerns and make complaints EVIDENCE: Two people spoken with said they felt safe within the home and that they were treated with respect by the staff and management. People were aware of how to raise concerns and who to talk to, but two people said they were not aware of how to make a formal complaint. People living in the home were observed as being confident and relaxed within their environment. The majority of staff have completed some training in Adult Protection and staff stated they were aware of how to raise issues or concerns and were confident about doing so. The home has a policy of not using restraint and over recent months have managed some challenging behaviours from a person who has now left the service. The information supplied to the Commission and the records showed that these difficult behaviours were managed in an appropriate and professional manner. Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are provided with spacious and homely accommodation that is decorated and maintained to a good standard. EVIDENCE: The home is decorated and maintained to a high standard and provides spacious and homely accommodation. There is a large secure rear garden and also an annex in the garden which can be used for activities. This room was also being used to store records at the time of the inspection and a requirement has been made in respect of this. It is recommended that some clarity is provided over the role and use of this space. People were positive about their bedrooms and are encouraged to personalise this space as they choose. People said that their privacy was respected by the staff Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 18 Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by a staff team that relates well to them and has a positive approach to their care and support. EVIDENCE: People living in the home were very positive about the staff team and all said they were able to talk to staff and that they were approachable. People said they were happy with the care and support they were receiving. Staff were observed communicating and interacting with people in a professional and respectful manner. Staff spoken with said they thought they worked well as team and that there were good levels of support and commitment within the staff team. There have been some difficulties due to the extended periods without a registered manager but some staff commented that they hoped the new manager could bring some stability and consistency. People felt there was now improved support and supervision being provided. Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 20 A sample of staffing records were examined and these were found to be in order, with the necessary checks being completed and recorded. The home has started having more regular staff meetings. There is a need for the training records to be better organised and for this aspect of the service to be better coordinated and planned but a sample of records showed that staff had completed the required statutory training and some staff had also completed some basic training in the managing of challenging behaviour. Some staff had completed some training in safeguarding but not all and the home must ensure that all staff have completed training in this area, and that this is recorded. Some staff are doing NVQ training but it was difficult to ascertain the exact percentage due to the lack of a comprehensive training matrix recording system. Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service needs to have a period of consistent management and leadership to ensure that improved and consistent outcomes are achieved and maintained for people living in the home. EVIDENCE: At the time of this inspection a new manager had recently been appointed and was waiting to go through the registration process. During their initial period they have had to manage a difficult situation around the discharge of one service user whose challenging needs could not be met by the service. They have also concentrated on addressing some shortfalls in regards to the office records and paperwork that had occurred during the extended period without a registered manager. The service is in need of a period of stability, leadership Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 22 and consistency if it is to successfully meet the needs of the people living in the home, as well as the new admissions that are planned to fill the three existing vacancies. There are some challenges to be met with regards to the issues around the admissions to the home outlined in some of the standards. The manager needs to establish the clear connection between documentation, needs and practice. Regulation 26 visits have been completed and feedback provided to the manager. With the number of changes there have been in terms of the management of the service over the past twelve months it has been difficult to develop any consistent form of quality assurance but the home must try and develop this aspect of reviewing and monitoring of the care and support. All health and safety checks have been completed and recorded and all fire safety checks completed and recorded. Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 23 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 X 2 1 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 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 x 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x 3 X 2 X X 3 x Version 5.3 Page 24 Linden House DS0000069034.V377858.R01.S.doc Are there any outstanding requirements from the last inspection? NO 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 YA2 Regulation 14 Requirement The home must ensure that comprehensive assessments are completed on any person moving into the home to ensure they are within the registration category and that the needs can be met. The home must supply evidence to the Commission that the two most recent admissions are within the registration category of the service. The home must ensure that all confidential information is securely stored. The service must ensure that people have the access to the specialist health care services there assessments indicate are necessary. The service must ensure that all staff have completed training in Adult Protection issues. The service must implement a system of quality assurance Timescale for action 30/12/09 2 YA2 14 30/12/09 3 4 YA41 YA19 17 13 30/12/09 30/12/09 5 6 YA23 YA39 18 24 30/04/10 30/04/10 Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 25 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. Refer to Standard YA1 YA19 YA24 YA35 Good Practice Recommendations The home could produce its Statement of Purpose and Service User Guide in different formats The service should introduce Health Action Plans for anyone living in the home The home should clarify the role or use of the annex in the garden. The home should introduce a training matrix system for the monitoring and recording of staff training Linden House DS0000069034.V377858.R01.S.doc Version 5.3 Page 26 Care Quality Commission Care Quality Commission South West Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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