Inspection on 04/02/09 for Lymewood Nursing Home

This inspection was carried out on 4th February 2009.

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

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

Other inspections for this house

Lymewood Nursing Home 26/03/10

Lymewood Nursing Home 06/03/08

Lymewood Nursing Home 25/08/06

Lymewood Nursing Home 09/02/06

Lymewood Nursing Home 05/08/05

Lymewood Nursing Home 10/02/05

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Lymewood Nursing Home Lymewood Nursing Home Woodhouse Uplyme Lyme Regis Devon DT7 3SQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rachel Fleet     Date: 0 4 0 2 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 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 Homes for Older People 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. 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 Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Lymewood Nursing Home Lymewood Nursing Home Woodhouse Uplyme Lyme Regis Devon DT7 3SQ 01297445444 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Lymewood Care Ltd care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: You may admit up to five service users with Dementia (DE) aged over 55 years, subject to individual assessment by local care management teams. Date of last inspection Brief description of the care home The home provides accommodation, personal and nursing care for those over 65 years of age who have needs related to dementia or a mental disorder. The home may admit up to 5 people with dementia aged over 55 years, subject to individual assessment by local care management teams. A maximum of 37 people can be accommodated. Mr Paul Stratton is the Responsible Individual for the Registered Provider, Lymewood Care Ltd. In a beautiful rural location about 2 miles from Lyme Regis, access to the home is via the centre of the village of Uplyme; the Woodhouse Road entrance is not used. The home has plenty of parking space, and its own transport, used to take people for health appointments, etc. Accommodation is on 3 floors, with stair lifts to all floors, Care Homes for Older People Page 4 of 31 0 0 Over 65 37 37 Brief description of the care home and a passenger lift between some areas. The manager assesses the suitability of bedrooms for prospective residents, considering the rooms location and the persons level of mobility. Some double rooms are available; several single rooms have ensuite facilities. There are two lounge-diners and a dining room off the entrance hall to the home, a small lounge in the newer extension, and a hairdressing room. People who would be at risk if they left the grounds unescorted can be given a device that alerts staff if they go through the gate into the drive. They can thus walk freely in the homes extensive gardens, with support given if they go further afield. In certain circumstances, people can bring existing pets with them when they first move into the home. Fees at the time of the inspection were 550-650 pounds per week, depending on whether people need nursing care or not. This was to increase to 550-700 pounds a week in April 2009. The fees did not include newspapers, hairdressing, and chiropody, which were charged at cost price. There was also a charge of 1.50 pounds per week for personal requirements such as toiletries. Our previous inspection reports are available from the home, which was last inspected on 6 March 2008. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection reported on below took place as part of our usual inspection programme. Our unannounced visit to the home lasted 10 hours on a week day, which included time spent with the manager Helen Gray discussing our findings at the end of the day. Prior to this visit, the home had returned a questionnaire (the Annual Quality Assurance Assessment, or AQAA), about the service they offered and any plans for the future. This included general information about the people living at the home and the staff, some assessment of what the home does well, and any plans for improving the service. As at our last inspection, there was an excellent level of response regarding surveys we sent out before our visit. All the surveys we sent for people living at the home were returned. These provided views in relation to 11 people living there, most of who had Care Homes for Older People Page 6 of 31 been helped to complete them by close family members. We sent 10 care staff surveys, and 9 were returned. Of 9 surveys sent to a range of community-based health or social care professionals, 6 were returned; all were positive about the home, with 3 specifically highlighting that the home managed to care for individuals who had very high levels of need due to their dementia. No-one indicated in their survey that they wished to speak to us. There were 32 people living at the home at the time of our visit. We met individually with at least 11 people around the home. Several people were not able to give us their views in depth, because of communication difficulties caused by dementia. Because of this, we sat for a while in the day rooms, using a particular method for observing activity that helps us get a sense of peoples well-being, how they are able to use their environment, and how staff support them. The inspection also incorporated case-tracking of 4 people living at the home, including new residents, someone cared for in bed, people who were privately funded and people who were funded through continuing care or Social services, as well as people we wished to follow up as a result of information from the AQAA, surveys, and the last inspection, to see if certain issues had been addressed. Case-tracking involved looking into these peoples care in more detail by meeting with them, checking their care records and related documentation (pre-admission assessments, etc.), talking with staff, and observation of care these people received. We spoke with 2 visiting relatives, 5 members of the care and ancillary staff, and the manager. Other records seen included those relating to staff, health and safety, and quality assurance. Our tour of the building included the kitchen and laundry. Information gained from all these sources and from communication with the service since the last main or key inspection (on 6 March 2008) is included in this report. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Whilst people are benefiting from increasingly person-centred care planning, more written detail in care plans would help to ensure their more diverse needs are met. More opportunities could be offered to increase peoples choice and control in their lives, promoting their rights. Continuing current staff training to its conclusion, so that staff achieve accredited care qualifications, will ensure people receive a safe basic level of care at all times. Care Homes for Older People Page 8 of 31 The safety and welfare of everyone at the home is generally well addressed, although further attention to one aspect of staff training would improve the level of protection offered. 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. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 benefit from various admission practices that help to ensure that the home can meet the needs of those who move in. The home does not offer intermediate care. Evidence: Most surveys said people had enough information before moving in, to help them decide if the home would be suitable. The exceptions were people admitted under continuing healthcare arrangements, when it was also said there was little choice of home. The homes Statement of Purpose was available outside the homes office, giving required information about the service it offered, in a standard printed format. A visitor told us that they had been given written information by the home, when they visited whilst looking for a suitable care home for their relative; they subsequently Care Homes for Older People Page 11 of 31 Evidence: found this to have been accurate information. The manager had asked about their relatives needs and their life history during this visit. One person said they were amazed by the many word of mouth positive comments they had heard about the home whilst making enquiries. Two people said the home was recommended to them, in one case by a health professional who knew someone who lived there. People we followed up had had comprehensive assessment of their needs by senior staff from the home, before moving in. One included particular detail about how the person liked to dress, what they enjoyed doing with spare time, what might cause them to appear distressed, particular risks to their health such as poor diet intake, their wishes in relation to their own serious illness or death, their faith and how their spiritual needs were to be met. The manager told us that, before they move in, everyone is sent written confirmation as to whether or not the home can meet their assessed needs. A visitor told us that their relative had waited for a suitable room to become available because of the individuals assessed mobility needs. People we spoke with felt they were made very welcome when they first moved in. Staff told us that they had the opportunity to read about peoples care needs before they arrived at the home. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The privacy and dignity of people living at the home is respected, promoting their selfesteem. They benefit from increasingly person-centred care planning, receiving more individualised care, although some lack of written detail means their more diverse needs may not be met. Improved medication management and multidisciplinary working ensures peoples health care needs are met. Evidence: A visitor said they felt the home showed care, understanding and a warmth that they had not seen in other homes they had been in. A visiting professional and other visitors commented that they had seen staff respond spontaneously and positively to individuals needs, in ways that showed a knowledge and understanding of that particular person. During our period of observation, most of the interactions between individuals and staff were positive, rather than neutral or negative. Another visitor was also satisfied with the care their relative received, confirming that the manager had involved them in reviewing the persons care plan, and they felt they could make any suggestions with regard to their care. Care Homes for Older People Page 13 of 31 Evidence: All surveys for people living at the home responded that they received the care and support they needed. A visitor commented that their relatives chair was always positioned where they could watch what was going on, which was very important to their relative. People we met generally looked well cared for, and we saw staff generally providing the care and support outlined in their care plans. The outcome of our observation period was that three of the four people we observed showed signs of wellbeing. The fourth person was in a less happy state for much of the time. They did little with their time compared to the others, and their interactions with staff tended to be neutral, rather than positive or negative. Staff surveyed felt they were given up-to-date information about peoples needs, and that there was good communication within the home. This latter point was reflected by a relative, when asked whether staff listened and acted on what people said. Care plans were comprehensive, and being written in a more person-centred way than previously. Staff were also beginning to include peoples strengths or abilities, and not just what help they needed. The plans were reviewed regularly and meaningfully, with the outcome of the planned care recorded. For example, whether peoples falls or certain health problems were being prevented, or that their social needs were being met. This gave good information as to whether the care plan was still appropriate or that it needed revising in order to meet the persons identified need. However, additional detail in care plans would help to ensure people got consistent care and support. One persons care plan said they liked watching TV, without being more specific, and some staff we asked did not know what programmes the person might like to watch. We met two people in a shared room. The care plan for one of them said they liked singalong type music, yet the radio in the room was playing classical music. Staff told us the other person preferred classical music, but it was not clear how this difference in tastes was to be managed. Where someone was noted to be a Catholic, care notes did not include whether or not they would want to have the Last Rites. Daily notes for someone referred to a continence aid which was not reflected in their care plan, nor was the type of equipment staff were to use in relation to their mobility needs. The latter might have been particularly significant in view of the fact that the person experienced pain. The manager told us that when people new to the home were sent a contract, a form was also sent asking for information on their life-story, things important to them, etc. Care Homes for Older People Page 14 of 31 Evidence: A relative confirmed senior staff had discussed this with them also. Care plans used information from specific assessments relating to individuals risks of becoming malnourished, falling or getting a pressure sore - to try to prevent or minimize any risk thus identified. We saw staff helping some people appropriately where they had mobility problems, using equipment and talking to the individuals about what they were going to do. Various sorts of pressure-relieving equipment was being used for people we met. However, we noted that the position of one person in bed did not change much. Staff confirmed they had been attended to regularly, although a turning chart in their room had not been completed, unlike for other people we met. All professionals surveyed said the home sought and acted on advice they gave; one thought this was a particular strength of the home. This was regarding, for example, individuals behavioral or wound care needs. Asked what the home did well, a GP replied that staff looked after difficult cases of people with dementia without asking that the individual be given medication to manage their problems. A visitor felt the home monitored people well, calling the GPs when necessary. Care records also showed that advice was sought from Community Psychiatric Nurses when the home felt it was unable to meet an individuals needs. The only comment on surveys as to how the home could improve was from a professional who noted that some incidents had not been recorded because staff considered them to be normal behaviour for certain individuals. They went on to say that the manager was addressing this. An optician visits the home, ensuring that people can have sight checks easily. There had been a query on one survey returned to us about whether the home attended to peoples regular sight and dental needs, so the manager agreed to include the subject in the next residents/carers meeting. She said there was difficulty getting regular dental attention for people at the home, but there was a good emergency service available at a local hospital. Someone was due to attend shortly, with staff using such appointments to give the person a longer, more pleasurable day out if they wished. One person we met told us they had physiotherapy but would like more exercise. A visitor told us the physiotherapist was trying hard to get their relative more mobile. Some care plans we looked at did not include the persons dietary likes/dislikes, apart from for hot drinks. But, as staff told us, this information was kept in the kitchen. The home gave people milky drinks with nutritional supplements added to ensure they got Care Homes for Older People Page 15 of 31 Evidence: a good intake, rather than asking for prescribed supplements. The manager agreed that this would be reflected in peoples care notes, to show they were getting the supplement drinks indicated in their care plans. Cranberry juice was also offered daily, as a drink that can help prevent urine infections. Professionals who commented thought medication was generally handled well, one reflecting that staff monitored the effectiveness of medication. A revised medication policy had been agreed with our Pharmacist inspector after our last inspection. Medications received into the home were recorded, as were unwanted items returned to the pharmacy. Medicine cupboards had been affixed in accordance with current regulations, and a medicine trolley had been obtained for taking medication around the home. We found controlled drugs were stored safely, with appropriate records kept of stocks and administration. Handwritten alterations to administration charts had been signed and dated. There were clear directions available to members of staff on how and when medicines prescribed to be used when required were to be used. The relative of someone who had lived at the home some years wrote In that time, she has been cared for with great kindness and respect. Professionals surveyed said the home usually or always respected peoples privacy and dignity, with two adding that any issues occurring during their visits were quickly noted and addressed by staff. We saw staff using the screens available in double rooms, to give individuals some privacy during personal care. Toilet doors had locking facilities. Whilst we saw that care staff knocked before entering bedrooms, other staff did not always do so, which the manager said she would follow up. A visitor told us that they visited at various times of the day, and their relative always looked tidy, with their nails attended to, etc. Others reflected this also. They added that a clothing sales company visited the home regularly, so that people could easily buy any items they needed. Asked in a survey what the service could do better, one staff member thought residents clothing could be improved, and implied that the home had a stock of clothing for shared use. We were unable to clarify the comment with the individual, but were assured by the manager on our visit that there was no clothing at the home for communal use. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities, and links with the community outside the home ensure people who live at the home enjoy variety as well as valued relationships in their daily lives. Peoples choice and control in their lives is promoted, protecting their rights, although this could be developed further. The nutritious and varied meals, eaten in pleasant surroundings, meets both their physical and social needs. Evidence: We saw individuals diverse interests had been recorded. We discussed with the manager if or how these were related to the homes record of activities that we were shown. She said this was still being developed and linked, so that individuals would be helped to continue the differing interests that they enjoyed before moving to the home. An activities programme was displayed, showing some events that did link to activities and interests in the individuals care records that we looked at. Relatives reported there were regular outings and entertainments, including live music at least monthly. However, some felt the person they visited was unable to take part in the activities arranged by the home because of the nature or severity of their mental health needs. Care records for one person said they did not have any particular interests previously, but care records showed they had attended the homes Care Homes for Older People Page 17 of 31 Evidence: parties, church service and musical entertainments. Photos displayed showed people enjoying the homes celebrations at Halloween and Christmas-time. Winter events had included a trip to see the Christmas lights, and a pantomime performed at the home. The home has a people carrier it can use for outings, although a larger vehicle was usually hired, which could carry wheelchairs. The home had also bought some relaxation equipment (color-phasing lighting, etc.), and a greenhouse had been built to encourage people in outdoor activities, since our last visit. A visiting professional said they had seen people safely using the garden. Care notes showed that some people attended the church service held at the home, or were helped to retain links with the church they used to belong to. A visiting professional told us the home had made great efforts to find community support for someone of another faith. A visitor told us about the monthly Carers group organized by the home for relatives and friends of people living at the home. Other events are held in relation to this group - such as fund-raising, social events, supporting and involving local charities or organizations such as the local majorettes. A relative we spoke with had been invited to the homes Christmas lunch, where staff had arranged for them to sit with people who had similar interests. One person had chosen to spend time in their room; others moved freely around the home as they chose to. Professionals surveyed said the home supported individuals to lead the life they chose, responding to their diverse needs. All surveys for people living at the home responded that staff listened and acted on what people said. We noted that when drinks were offered people were not always given a choice, although tea and coffee were both available. Staff told us that most people preferred tea but some were known to like coffee. It would be good practice to offer a choice, however, for various reasons. People who responded when we spoke with them told us they like the meals at the home, and surveys reflected this. A relative reported that one person had a liquidized diet, and seemed to enjoy it. A visitor described the food as excellent, adding that they could join their relative for a meal, with notice. Another said the meat was tender, gravies were tasty, pudding sponges light, with at least two fresh vegetables offered in addition to potatoes. Two people commented that their relatives variable intake at mealtimes was not a Care Homes for Older People Page 18 of 31 Evidence: reflection on the food provided but part of their condition. We found that kitchen staff were on duty for 10 hours a day, with staff saying they were thus available to make people snacks between mealtimes should they eat little at the mealtime itself. We discussed that menus showed only one meal option at lunchtime. We were told that alternatives were made at the time if an individual declined what was given to them. We saw someone was offered a sandwich, which they ate, when they didnt want the hot meal offered at lunchtime; their visitor later told us this was a usual part of their relatives care. We did discuss with staff that some people were given cheese and biscuits - quite a dry meal - without a drink available. The meal time was a sociable event, with staff available and checking that people were eating their meal, offering seconds to some. Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 can be confident that complaints are taken seriously and that they are protected from various forms of abuse, safeguarding their welfare. Evidence: All surveys for people living at the home indicated relatives knew who to speak to if not happy, with all but one saying they knew how to make a complaint. Professionals surveyed said the home always or usually responded appropriately to any concerns raised. All staff surveyed said they knew how to respond if someone had concerns about the home. We have not received any complaints about this home since our last inspection. There had been one safeguarding referral in relation to this home since our last inspection, the referral being made by the manager. It was dealt with through the local authoritys safeguarding procedures, with the co-operation of senior staff at the home. On our visit, one person told us the staff treated everyone very well, whether frailer or more able. We saw staff physically and verbally assisting people in polite and gentle ways. The homes Safeguarding policy had been updated since our last visit and was generally comprehensive. However, it didnt include contact details for organizations outside of the home that could be contacted by staff if they had concerns, and this was one area of knowledge that staff, overall, were less knowledgeable about. The Care Homes for Older People Page 20 of 31 Evidence: manager said staff training had included this information, and some staff knew that relevant phone numbers were displayed in the office. Staff we spoke with were clear about their responsibility to report bad practices if they witnessed them. Information was available to staff on the Mental Capacity Act 2005 Code of Practice and the Deprivation Of Liberty safeguards. Care plans included considerations of individuals capacity to make certain decisions for themselves. Appropriately, staff had carried out a risk assessment, in relation to one person we case-tracked, for use of bedrails. These are a potential restraint, and they can create other risks. The risk assessment showed that the bedrails were not to be used currently, specifying other ways of managing the identified risk to the person from falling or getting out of bed when unattended. For another person, it had been decided to use a monitoring device so that staff could be alerted to assist them in certain circumstances. Such devices can affect peoples privacy or liberty, and the home had accordingly discussed its use with others before its use was agreed. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 enjoy accommodation that is homely and clean, benefiting from ongoing improvement of facilities and adaptations both inside and outside of the home. Evidence: A visitor commented There are flowers in the entrance lobby which make it friendly and welcoming. A few bedroom doors had pictures on them to help the room occupant identify their own room. Bedrooms looked pleasant, colourful and individualized within. Most people had their own possessions and familiar items such as photos of family or pets. Some rooms had a lockable facility, for safekeeping of valued or valuable items. Some people told us that they were happy with their room, their bed was comfortable, and the facilities such as heating and lighting were sufficient. A few bedroom doors had locks; one person who did not have a lock on their bedroom door said they didnt feel they needed one. One bedroom had towels and a chair that were beginning to look worn. The manager said she would follow this up promptly since there was ongoing replacement of such items. Some en suites had chairs in them, for those who found it easier to sit whilst washing. We saw raised toilet seats and hand rails had been fitted for individuals who could benefit from them. Lever taps had been fitted in some places, which were easier to Care Homes for Older People Page 22 of 31 Evidence: use than conventional designs. There were some specialist armchairs for people who could not comfortably or safely sit in the more domestic ones. We noted in the lounge that some people had nowhere convenient to put a drink or their empty cups. And occasionally, because of the arrangement of furniture, staff had to stand when helping seated people with drinks, because there was nowhere to sit. The manager said she would look into these matters. A visitor thought the lack of a passenger lift to all areas of the home was disadvantageous, with one person expressing difficulty getting around the home because they occupied a room on an upper floor. The manager confirmed a room on a lower floor would be offered as soon as one was available. A log was kept of repairs carried out around the home. Staff told us these were attended to promptly, and that equipment such as the chairlifts and washing machines worked reliably. The AQAA confirmed servicing of facilities was up-to-date. Fire safety checks had been recorded regularly, and a fire drill had been carried out in December 2008. Fire risk assessments had been carried out for each room at the home, taking into account the needs of the occupant where bedrooms were concerned. Surveys for people living at the home indicated the home was always or usually fresh and clean. Relatives comments included that this had improved in recent years, that Lymewood is always impeccably clean, Floors and curtains, bedrooms and bathrooms are very clean, and it had a lack of any unpleasant smell compared to other homes visited. On the day of our visit the home was free of malodours apart from one bedroom, which the manager said she would investigate. Staff we spoke with had good knowledge of how to prevent the spread of infection. We saw they wore different colored aprons for serving food and for giving personal care, using disposable gloves and aprons as necessary. Appropriately, a particular type of bag was used to carry soiled washing, although we noted staff were then sorting through these bags to separate different types of fabrics. Such action creates a cross-infection risk to staff, which would be avoided by use of alternative sorting procedures. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 are looked after by a caring, knowledgeable and skilled staff team, who are recruited using robust procedures, promoting peoples welfare. They will benefit further from current ongoing staff training, which ensures people receive a safe basic level of care at all times. Evidence: When we arrived, the manager was on duty with another nurse and 5 care assistants, looking after 32 people. They were supported by a cook, a kitchen assistant, a cleaner and a gardener. Cleaners and cooks are employed to work every day, including weekends, enabling care staff to concentrate on care duties. Surveys for people living at the home said that staff were always or usually available when they needed them. One added that staff could be very busy, whilst another said Whatever I need from the staff, they are always there on hand, even when they are very busy. People described staff as very friendly and helpful, very kind and professional. One said they had great admiration for the whole team. Most staff surveyed thought there were usually or always enough staff on duty, with two mentioning shortage due to staff sickness. The AQAA indicated the home uses some agency staff. One staff member told us that the manager will work hands on when necessary - if someones condition deteriorated, for example. During our visit, Care Homes for Older People Page 24 of 31 Evidence: staff remained occupied but did not rush anyone, taking the time to give explanations, etc. when with people. A visitor told us there was a stable staff team at the home. We looked at staff files for the only two staff who have been employed since our last visit, one of who had been employed at the home before. These files had the required information in them, such as evidence of identification, two references and police checks obtained before people started working at the home. Where information obtained initially had not been satisfactory or sufficient, the manager had followed this up, recording her action. Though no-one at the home had a recognized mental health qualification, the manager and the deputy had over 16 years of experience in this field. Ten staff were undertaking the Certificate in Dementia Awareness. Attempts to recruit staff with appropriate qualifications for this area of care have been ongoing for some time. Almost half of the care staff had a recognized care qualification, and others were working towards one (- which would help the home to exceed the recommended minimum that half of all care staff are trained). A staff member had recently qualified as an assessor for the care course, and was also responsible for seeing that new staff worked through a nationally recognized induction programme. They were undertaking a teaching course to help them in their training role. Staff surveyed felt they had had appropriate inductions, and that they were given training that helped them keep up-to-date with good practice as well as meet peoples more diverse needs. With regard to the latter, one staff member said staff shared their knowledge with their peers if they had to find out more about a particular need. The training programme mainly consisted of safe working practice topics, which staff confirmed they had recently undertaken. It included diabetes, a condition that some people at the home had; this training was given by the local community nurses. Training had also been given on helping people safely with their meals if they had swallowing difficulties, etc. Some staff had recently completed a course on palliative care. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the people living there. The safety and welfare of everyone at the home is generally well addressed, although further attention to one aspect would improve the level of protection offered. Evidence: Helen Gray, the Matron and Registered Manager, is an experienced Registered General Nurse, who has cared for people who have dementia for many years. Since our last visit, she has attended training on Deprivation of Liberty safeguards, and is still trying to undertake updating through a safeguarding management course run by the local authority. She is the manual handling trainer for the home, so has annual updating for this role. A relative said they felt Confident in the professionalism of the manager and her deputy. Another said Lymewood is welcoming. The senior staff are very aware of the person that was and the vulnerability of that person now. They are also a great support to the grieving relative who finds visiting so sad. And a third told us This Care Homes for Older People Page 26 of 31 Evidence: home is very comfortable and all the people seem to be happy as they can. It is run extremely well and Im so glad my husband is there. Two staff members commented that the manager monitored staff practice, speaking to them immediately but in an agreeable way if she felt improvement was needed. She had also identified areas for improvement at the home in the AQAA submitted to us. Staff surveyed said they met regularly with the manager for support and to discuss their work. Those we spoke with confirmed that there were regular staff meetings with minutes made available, as stated in the AQAA. One told us that our reports were discussed, and they could discuss any issues, including care matters. They also said they had supervision sessions with senior staff, with suggestions acted on (such as a fire drill for night staff). Asked what the service did well, one staff member said that management listened and tried to do their best for the residents. In addition to seeking peoples views at the regular carers/relatives meetings, the home sends out surveys for people living at the home and to staff. Results are shared at the carers and staff meetings, which are both minuted. The home did not keep any personal monies for people living at the home. A sundries account was kept for each person. A bill was sent in arrears every 3 months, with relevant receipts. We saw receipts had been obtained from the hairdresser and a clothing company, for example. People were charged a flat rate of £1.50 weekly for personal requirements such as toiletries, ensuring no-one was ever without basic items. The manager said if larger expenditure was required (such as for clothing), the next-of-kin would always be consulted before any money was spent. Staff felt they had a safe working environment. They said they could ask for more equipment if they felt they needed it, and items needed for daily care-giving were never in short supply. This included disposable items, used for preventing the spread of infection. We saw records of monthly safety checks for window restrictors, hot water, bedrails and wheelchairs. Bath water was of a satisfactory temperature where we checked it. Radiators had been covered, to control risks of scalds. Labels on portable electrical items indicated they had been checked for safety within the last year. We saw that the home was putting into practice current food safety guidance, and using kitchen cleaning rotas, keeping records of any change to the printed menu, etc. The cook said she had had food hygiene training at the home but not yet undertaken an accredited food safety course. Care Homes for Older People Page 27 of 31 Evidence: We discussed falls that had occurred at the home. The manager told us she had been monitoring peoples falls regarding any pattern or avoidable factors, and that as a result staffing in the evening had been reviewed. Two staff were to remain in the lounge/entrance area, where half of the falls resulting in more serious injuries had occurred, at that time of day. Visitors told us that there was always a member of staff in the lounges. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 It is recommended that you continue to develop individuals care plans in a person-centred way, so that staff have good information on how to meet their diverse needs. It is recommended that people are always offered a choice, including a choice of drinks at mealtimes and when drinks are served at other times. It is recommended you continue efforts to achieve a minimum of 50 trained care staff at the home. It is recommended that the homes cooks undertake an accredited food safety course. 2 14 3 4 28 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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