Care Home: The Links

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What the care home does well The links continues to provide a homely, caring and supportive environment. Staff are dedicated to meeting the needs of people living in the home in a personal, Person centred way. A loop system is available in the home for people who have a hearing problem and can be made available on request. The opinions of people in the home are valued, encouraging independence and taking into account the need to respect dignity and privacy. Comments received about The Links were very positive, most of the people living in the home had completed a written survey and indicated they did not wish to talk to an inspector. Comment on the surveys were, `I am very happy living here the staff are very helpful,` `I am helped and supported at all times by excellent staff,` and I receive excellent care and the staff are very nice and cheerful.` One resident spoken to said she could not have made a better choice. Relatives indicated that they were very happy with the care provided. One commented that `they tend to mums needs in a lovely caring way.` Another stated that they owed the staff a debt of gratitude for the level of care their mother had received. What has improved since the last inspection? At the last inspection two recommendations were made these were in relation to medication issues and infection control. All elements of both the recommendations had been acted upon. Risk assessments were in place for people living in the home who are managing their own medication. A bound numbered book for recording controlled medication had been provided and all entries for variable doses showed the amount that had been given. Downstairs communal toilets/bathrooms had been equipped with paper towels. Since the last inspection person centred care planning has been introduced and developed to meet the assessed needs of people living in the home. What the care home could do better: No requirements and two recommendations were made following this inspection. The handwritten medication record for people staying in the home on respite did not have a signature this is not good practice. Handwritten entries on medication charts need to be signed by the person making the entry and witnessed by another member of staff. Although activities are carried out in the home a clear record was not being maintained. It was difficult to evidence that residents were being offered the chance to follow a meaningful activity. A daily record of activities followed in the home needs to be maintained. CARE HOMES FOR OLDER PEOPLE The Links 7 Uphill Road North Weston Super Mare North Somerset BS23 4NE Lead Inspector Juanita Glass Unannounced Inspection 16th January 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Links Address 7 Uphill Road North Weston Super Mare North Somerset BS23 4NE 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) 01934 625869 01934 419244 cl-manager@bihcg.co.uk WSM Free Church Housing Association Mrs Mair Wynne James Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd November 2006 Brief Description of the Service: The Links is owned by Abbeycare, the Weston-super-Mare Free Church Housing Association and is situated on the seafront road. The home is in a converted older property and offers accommodation on two floors. A chair lift and staircase provides access to the upper floor although a few steps still need to be negotiated on the ground floor and first floor. The large lounge overlooks the well-maintained landscaped gardens and the dining room has a view of the local golf course. A well-stocked library is available in the reception area. Daily prayers and a church service every two weeks are held in the lounge. Although optional, the majority of residents choose to attend these services. The town centre with shops and recreational activities is close by and transport would be required to access this. Current fees £356 per week. The Links DS0000008064.V351567.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 stars. This means the people who use the service experience good quality outcomes. This inspection took place over one-day and a total of six hours were spent in the home. To gather enough evidence to support our judgments for this inspection, we the commission asked the service provider to complete an Annual Quality Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people living in the home. It also gives us some numerical information about the service, and how they intend to maintain or improve outcomes for people using their service. We also looked at surveys returned to us by people living in the home and people with an interest such as relatives, social workers and GPs. We received 14 surveys, 9 from people living in the home, 4 from relatives and 1 from a GP. Once we had received this information we carried out a visit to the home and spoke to people living there, staff and relatives. Whilst in the home we also looked at documents maintained for the day-to-day running of the service. These included care plans, staff recruitment, training and supervision. Also records relevant to the administration of medication, service records and health and safety. What the service does well: The links continues to provide a homely, caring and supportive environment. Staff are dedicated to meeting the needs of people living in the home in a personal, Person centred way. A loop system is available in the home for people who have a hearing problem and can be made available on request. The opinions of people in the home are valued, encouraging independence and taking into account the need to respect dignity and privacy. Comments received about The Links were very positive, most of the people living in the home had completed a written survey and indicated they did not wish to talk to an inspector. Comment on the surveys were, ‘I am very happy living here the staff are very helpful,’ ‘I am helped and supported at all times by excellent staff,’ and I receive excellent care and the staff are very nice and cheerful.’ One resident spoken to said she could not have made a better choice. Relatives indicated that they were very happy with the care provided. The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 6 One commented that ‘they tend to mums needs in a lovely caring way.’ Another stated that they owed the staff a debt of gratitude for the level of care their mother had received. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 8 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): 1, 3 and 5 6 does not apply Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People intending to live at The Links benefit from sufficient information to make an informed choice, they are also offered the chance to visit the home before finalising the decision to move in. A full needs assessment is carried out ensuring the home can meet their assessed needs. The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 9 EVIDENCE: The homes Statement of Purpose is reviewed annually and reflects the service provided by the home. A copy of the service User guide is made available in residents rooms. Four care plans were reviewed they all contained pre admission assessments which identified the specific needs of the prospective resident. The manager confirmed that they would only take new resident when they were sure they could meet their needs. The pre admission assessment forms the basis of the full care plan, which is then agreed with the resident. People wishing to move into the home are offered the chance to visit and spend some time in the home when they can talk to staff and residents about their experiences. One person living in the home said they had visited three other home before The Links and had a chance to talk to staff before making the decision to move in. Another resident said their daughter had, ‘done the leg work,’ then she had visited the home with her before making the final decision. The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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 benefit from a person centred approach to care. They are encouraged to maintain their independence and are treated with respect and dignity. They have access to healthcare specialists and are enabled to manage their own medication when appropriate. EVIDENCE: Since the last inspection a person centred approach to care has been implemented. All the care plans seen reflected this approach with clear guidelines for staff about peoples likes and dislikes and the way in which they preferred to receive their care. On admission a resident is asked to complete a ‘getting to know you questionnaire’ which tells staff about their lives and the way they wish to live. All care plans contained appropriate risk assessments and showed signs of regular review. The manager confirmed that the staffing structure had been reviewed freeing staff up to carry out their care plan reviews in a one to one session with the resident. The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 11 Staff spoken to said the new person centred care plans were really good because they spent time getting to know the resident better. Residents indicated in the written surveys that they agreed their care plans and one relative said that ‘staff followed their fathers care plan to the letter and kept her informed of any changes.’ All the care plans reviewed showed evidence of residents being assisted to access healthcare specialists, such as the chiropodist, dentist, optician, diabetic nurse, district nurse and to attend appointments at clinics, GP surgery or the hospital. One resident said that their daughter always went with them to the GP or hospital but that staff were always ready to go with them if needed. All residents spoken to said that the care they received was delivered in a caring and respectful manner. They said that staff were very good in following their care plans so their preferences were respected. Written surveys from people living in the home said, ‘I receive excellent care at all times staff are very caring,’ ‘I am very happy here the staff are so good to me.’ Relative comments received said, ‘They tend to all mums needs in a lovely way,’ and ‘the staff generate loving care and kindness.’ The homes policies and procedures for the receipt storage and administration of medication are robust and staff receive training before they can administer medication. Some residents administer their own medication following a full risk assessment of their understanding. An audit of the administration and storage of medication showed that there were no errors. Staff had handwritten two Medication Administration Charts for people on respite care. The person making the entry did not sign these charts and this does not reflect good practice. The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 12 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 benefit from an approach that recognises them as individuals, and routines are built around needs and preferences rather than staff convenience. A meaningful programme of activities is provided. Menus and meals are good, and alternatives and extras are readily made available. The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 13 EVIDENCE: People spoken said that a varied and meaningful programme of activities is provided, however it was difficult to evidence this, as a full record of daily activities is not maintained. This was discussed with the manager who agreed that a clearer record would be kept of all activities and who took part. Although there was no written evidence people living in the home confirmed that they could attend an activity and during the summer had been out on trips which they were looking forward to starting again. They also felt that as they were a small community it was difficult to organise large events as many of the people living in the home [refered to follow their own activity such as enjoying a book, TV or music in the privacy of their own room. Those records that were available showed that a dedicated member of staff was available to accompany residents on walks or shopping trips and to play board games or organise a craft session. People also confirmed that their relatives and friends are made welcome in the home. During the inspection relatives were seen to come and go throughout the day. They commented on the friendly and welcoming approach of staff who would assist them to find the person they were visiting and make the visit a pleasant one. The main ethos in the home is that people living there are given the chance to take control of their daily routine wherever this is practicable; people are given a degree of choice in most aspects of their lives. People spoken to said that they could exercise choice and control over their own lives and felt that the home was run for their benefit. Staff spoken to were very conscious of enabling people living in the home to continue to make personal choices. People living in the home are asked on a daily basis about their meal preference. This is then conveyed to the cook. If a person does not want either choice another option can be offered. There is a good range of hot and cold options offered at each meal. The menus continue to contain a variety of well-balanced meals that reflect the preferences of the people living in the home. The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 14 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 benefit from a clear complaints procedure that they can understand. The procedure is clearly displayed throughout the service and is given to other agencies involved with the home. The manager and staff have received training in safeguarding adults and how to respond in the event of an alert. The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 15 EVIDENCE: The home’s complaints policy and procedure shows a clear timeline and action to be taken in event of a complaint. A copy is clearly displayed in the home and in resident’s rooms. Subsequent copies are available on request. The policy and procedure also directs the complainant to the CSCI. The manager maintains a full record of complaints. No complaints were recorded; the deputy manager stated that residents tend to discuss anything they wish to mention over breakfast. A copy of the North Somerset policy and procedure for Safeguarding Adults under No Secrets has been made available for all staff. Staff spoken to showed an awareness of the policies and procedures in place to safeguard vulnerable adults. Staff records showed that staff had received appropriate training. The home also has a very clear whistle blowing policy, which all staff spoken to were aware of. People spoken to said they knew how to make a complaint if they needed to, they all felt they could approach the owners at anytime with any concern and that it would be considered seriously. The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 16 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 and 26 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 benefit from a well maintained, homely environment, in a service that provides aids and equipment to meet the care needs of the residents. It is a very pleasant safe place to live with rooms that meet the national minimum standards. A high standard of cleanliness is maintained within the home. The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 17 EVIDENCE: We carried out a tour of the premises. The Links is homely with a variety of communal areas with views across the golf course, which is furnished so that people living in the home can sit in small groups. The furnishings and lighting are domestic in style whilst providing adequate light to read by. The furniture and fittings are of good standard and communal areas are pleasantly decorated. A programme of re-decoration is being followed as and when rooms become available. People spoken to said that they liked their rooms and had bought in their own furniture which made them feel more at home. People living in the home also have access to outside areas. The home shows a good standard of housekeeping and no offensive odours were apparent. The manager and staff showed a clear awareness of infection control policy and guidelines. Since the last inspection communal toilets have been equipped with paper towels. Protective clothing was being used when appropriate. The manager can obtain guidance from outside agencies if required. The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 18 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): 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 benefit from sufficient numbers of staff to meet their needs on a daily basis with more staff being available at peak times of activity. The service ensures all staff receive relevant training focused on delivering improved outcomes for people within their service however this has fallen behind schedule. The service has a good recruitment procedure that clearly defines the process to be followed. The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 19 EVIDENCE: Staffing rotas showed that the home is adequately staffed for the diverse needs of the people living in the home. Extra staff can be used at peak times or for activities. In the morning there are two general assistants one senior staff member and a cook. This reduces to a general assistant and one senior staff member in the afternoon with two sleeping night staff. The manager confirmed that staff had been freed up to spend more time with residents on a one to one basis by the introduction of a dedicated activities person. Staff were observed during the day. All observed interactions with service users were heard to be kind and helpful. The care staff at the home are encouraged to undertake National Vocational Qualification (NVQ) training and the home currently has 50 of the care staff holding an NVQ qualification of level 2 or 3. With other staff either attending the training or planning to start. All new staff receive Induction training following the Common Skills for Care Induction. The manager confirmed that training had fallen behind schedule as their training officer had left however the area manager was organising training and records showed that most mandatory training had been attended through the year. Most staff had also attended training in Safeguarding Adults, medication administration, dementia and challenging behaviour. The Links has a good recruitment procedure that clearly defines the process to be followed. Three staff files were examined for new starters in the last twelve months, all had a CRB and relevant information on file. The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 20 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, 36, and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the required qualifications and experience to run the home and is supported in this role by the deputy manager. They encourage an open and inclusive ethos. Staff supervision is planned but not followed effectively. Efficient systems are in place to monitor the quality of the service provided. The home works to a clear Health and Safety policy, which all staff are fully aware of. The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 21 EVIDENCE: Mrs Mair James is the Registered Manager and holds the Registered Managers Award. She has several years experience in the care sector. Her ‘open door’ policy enables staff and residents to discuss any issues with her. She continues to be liked and respected by residents and staff alike. Residents meetings continue to be held although it is difficult to persuade them to attend monthly. They are encouraged to discuss their views on the way the home is run and the facilities provided. The deputy manager said that breakfast is a time when residents tend to get together for a general discussion. An annual survey of residents’ views is carried out; when these are returned and collated a meeting is held to discuss any issues arising. The last survey raised the issue of activities and trips so residents were asked for their suggestions. The Annual Quality Assurance Assessment (AQAA) returned to the CSCI was clear about the homes commitment to maintaining an environment that recognises the diverse needs of the people in their care and developing a service that will meet those needs on an individual basis. The manager confirmed that the plan for staff supervision is a skill scan and competence audit, which should take place six times a year. This had not been followed and had been happening twice a year. Due to the size of the home the manager and deputy manager regularly work alongside staff and discuss issues raised at anytime. So supervision is followed but not recorded formally. Low staff turnover shows that staff do feel supported. Staff stated that they felt they could talk to the manager at any time so felt well supervised. Records relating to servicing of equipment in the home were reviewed. All records were up to date and available for inspection. The implementation of health and safety within the home was satisfactory. All residents have personal risk assessments. Generic risk assessments are in place and reviewed regularly. A review of the firelog showed all tests, training and drills were being carried out to the Avon and Somerset Fire Brigade guidelines. The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 22 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 3 X 3 X 3 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 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 3 The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations Handwritten entries on medication charts need to be signed by the person making the entry and witnessed by another member of staff. A record of activities followed needs to be maintained 2. OP12 The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Links DS0000008064.V351567.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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