Inspection on 09/02/06 for Lymewood Nursing Home

This inspection was carried out on 9th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lymewood Nursing Home 26/03/10

Lymewood Nursing Home 04/02/09

Lymewood Nursing Home 06/03/08

Lymewood Nursing Home 25/08/06

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Lymewood Nursing Home Lymewood Nursing Home Woodhouse Uplyme Lyme Regis Devon DT7 3SQ Lead Inspector Stephen Spratling Unannounced Inspection 9th February 2006 10:30 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 Lymewood Nursing Home DS0000061709.V273912.R01.S.doc Version 5.1 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. Lymewood Nursing Home DS0000061709.V273912.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Lymewood Nursing Home Address Lymewood Nursing Home Woodhouse Uplyme Lyme Regis Devon DT7 3SQ 01297 445444 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) Lymewood Care Limited Mrs Helen Mary Gray Care Home 37 Category(ies) of Dementia - over 65 years of age (37), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (37) Lymewood Nursing Home DS0000061709.V273912.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. You may admit up to five service users with Dementia (DE) aged over 55 years, subject to individual assessment by local care management teams. 5th August 2005 Date of last inspection Brief Description of the Service: Lymewood has been under new ownership since November 2004. The home provides accommodation and personal care, including Nursing, for up to 37 older people (over 65) who have needs that relate to dementia or a mental disorder. The home can admit up to five people between the ages of 55 and 65. Set in a beautiful rural location about two miles from Lyme Regis, Lymewood has a wide selection of accommodation on three floors with attractive accessible gardens. All areas are serviced by a stair lift and some by a passenger lift. There is one main lounge, one dining room, and three smaller lounges. Lymewood also has a small shop and a hairdressing salon. Lymewood Nursing Home DS0000061709.V273912.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out by one inspector (Stephen Spratling) from 10.30 am until 5 pm on 5th August 2005. During the day the inspector spoke with the registered manager, three members of care staff, nine of the people living at the home and the relatives of one resident. The mental frailty of many of the residents who the inspector spoke with prevented them for being able to express clear views about the service they receive. Additionally he looked briefly at the assessments and care plans for three residents; some of the policies and other records kept by the home. A limited number of the National Minimum Standards were looked at during this inspection and for a fuller picture of this service the reader is advised to also see the last inspection report of 5th August 2005. Issues that should be noted, but that are not in the main body of the report as they do not relate directly to Standards inspected, include evidence of ongoing investment to improve the building and that all staff spoken with indicated that they enjoy working at the home. What the service does well: What has improved since the last inspection? What they could do better: Further work should be done to ensure each individual residents need for stimulation is recognised and met in a way that suits them and staff need to ensure that confused residents are suitably supervised at all times. Lymewood Nursing Home DS0000061709.V273912.R01.S.doc Version 5.1 Page 6 As this home offers a Specialist service for people experiencing Dementia or Mental Health problems all staff should receive training about Dementia and mental health care to ensure they have the skills to care for residents in the best way possible. All staff should be trained to ensure they would recognise and know how to report abuse. Soiled laundry needs to be washed hotter to ensure it is properly disinfected. The homes door alarm needs to be adjusted/changed to make it less intrusive. Arrangements for preventing fire and ensuring fire evacuation routes are clear need improving. 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. Lymewood Nursing Home DS0000061709.V273912.R01.S.doc Version 5.1 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 Lymewood Nursing Home DS0000061709.V273912.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed during this inspection. EVIDENCE: Lymewood Nursing Home DS0000061709.V273912.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 Robust systems, which are properly implemented, help to ensure that residents receive the medications they need safely. EVIDENCE: The inspector saw that the home has proper secure storage for medications. Four residents medication charts were examined and all were completed properly indicating when medication was given and when/why omitted. Each medication chart had a photo of the service user attached. Charts showed that medications are checked into the home properly and a clear audit trail to the point of use or disposal was evident. The inspector was shown record of a pharmacist having conducted a medications systems audit within the past 12 months. Lymewood Nursing Home DS0000061709.V273912.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 & 15 Social activities are provided at the home providing some variation and interest for residents, however further work is need to ensure the each individuals residents need for stimulation is recognised and met. Residents benefit from being supported to spend time where they choose. Good food is provided, served in a pleasant atmosphere, with individual support given discreetly as needed. EVIDENCE: Three residents able to comment said they like the food provided at the home. Staff told the inspector that drinks are provided at regular intervals but snacks and drinks can be provided at any time on request. The inspector was present during lunch; residents sat in three different areas around small tables together. The atmosphere was relaxed, unrushed and residents were sensitively supported to eat as independently as they could. The meal served was hot, was pleasantly presented and residents appeared to enjoy it. Staff were seen taking meals to residents who chose to eat in their rooms. Residents able to confirmed that they can spend time in their rooms or shared areas as they choose. Residents were seen moving freely around the shared areas of the home, the level of confusion experienced by many residents means that staff need to divert them from going out unescorted to ensure their safety Lymewood Nursing Home DS0000061709.V273912.R01.S.doc Version 5.1 Page 11 which staff did sensitively; two residents do go out unescorted but wear devices to alert staff if they leave the grounds helping to keep them safe but maximise their independence. During the course of the inspection the inspector did not observe residents being engaged in any recreational activity by staff, though one resident spoken with was enjoying looking at an historical book and others had current news papers. The home has an activities coordinator who also works as a senior carer fitting her activities role around her carer duties. She showed a good awareness of the need for many of the homes residents to have one to one attention to do activities and said she had attended training about doing activities though this had not been specifically about activities for people with dementia. One residents care needs assessment said that they liked puzzles, gardening and going to the pub; records did not make any reference to them taking part in any of these activities. The activities record for another resident mentioned them participating in a ball game twice in two months but nothing else. The manager felt that this was because other activities had not been recorded rather than nothing else had been done. Other staff told the inspector that there are usually activities each day including, ball games, reminiscence sessions, a weekly visit by an organist and regular church service for those wishing to attend. Lymewood Nursing Home DS0000061709.V273912.R01.S.doc Version 5.1 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Residents can be confidant that their complaints would be taken seriously and that the manager would act to protect them if they were being abused. However there remains a risk that staff would not know the correct procedures to follow if they had concerns about abuse of a resident. EVIDENCE: The homes complaints policy was seen on display in the homes entrance hall. A regular visitor to the home told the inspector that the manager and staff are very responsive to any concerns expressed. The manager said she had received no formal complaints in the last year. The three staff spoken with during this inspection showed common sense when asked what they would do if they were concerned that a resident was being mistreated and said they would inform the manager who has given all staff her home contact number to use if they have such concerns. However one senior member of staff, in post nine months, had not had any training about recognition or reporting of abuse and was not aware of the correct procedure to follow if they had concerns or concerns were reported to them. Lymewood Nursing Home DS0000061709.V273912.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 The home provides a homely domestic atmosphere though a loud door alarm disrupts the homely atmosphere for residents. The arrangements for preventing the spread of infection within the home are not adequate. EVIDENCE: The environment was not inspected in detail during this inspection though all areas seen were clean, well maintained and no unpleasant odours were detected. The home furnishings are domestic in appearance. Due to the level of confusion of many residents the homes external doors set of an alarm to alert staff when opened; this alarm went off several times during the inspection, it is extremely loud and invades the otherwise homely peaceful atmosphere. The inspector visited the home laundry and spoke with the laundry staff member. The laundry room was well organised and clean. The member of staff said that she is provided with the equipment she needs to do the job. She told the inspector that heavily soiled sheets are delivered to her in soluble bags which can go straight into the machine and that these items are then washed Lymewood Nursing Home DS0000061709.V273912.R01.S.doc Version 5.1 Page 14 twice at 60oC; this is not hot enough to ensure adequate disinfection. No written guide/procedure as to how laundry should be managed was available. Lymewood Nursing Home DS0000061709.V273912.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Residents benefit from being cared for by kind patient staff, however they cannot be confident that staff will always be around/visible or that all staff have the knowledge and skills, to ensure their needs are met in the best way possible. Recruitment procedures are not sufficiently robust to maximise protection of residents. EVIDENCE: The recruitment records of two members of care staff, recruited within the past 12 months, were looked at (the manager said none had been recruited since the last inspection). One contained only one written references though record of two verbal references was seen, a Criminal Records Bureau (CRB) check was present though dated as received four months after the carer had started in post. The second contained most of the required checks including two references though one of these was not dated and neither was from the persons last employer as it should be; a copy of a CRB check was available in the file but this had been conducted by a previous employer and should have been repeated before the person started to work at Lymewood. Both files contained record of the staff members having received a structured induction when first working at the home; one also indicated that the carer had received other training but neither showed record of either having had training about care of people with Dementia or other mental health problems. The Registered Nurse spoken with had been in post nine months and was registered as a Lymewood Nursing Home DS0000061709.V273912.R01.S.doc Version 5.1 Page 16 general nurse. She said that she had no prior experience of caring for people with Dementia and had not had any training on this area of practice since starting at the home; she confirmed that sometimes she is the most senior member of staff on duty. The manager reported that 11 of the 16 carers employed have done NVQ qualifications and 2 are about to start. The inspector observed staff speaking with residents nicely, respectfully and on all occasions being gentle, however on two occasions a carer was seen to provide care to resident’s without adequate explanation or gaining consent where the residents were capable of giving it. A visitor to the home who described the care provided at the home as “excellent” indicated that they always see staff being kind to residents. Staff indicated that generally staffing levels are sufficient to ensure they can provide care to residents in an unrushed manner. On the day of the inspection there were 7 carers, one Registered Nurse and the manager on duty, who were seen working steadily and patiently with residents, staff were seen responding respectfully to residents. Residents indicated that they get help when they need it. The inspector spent periods observing sitting in the large lounge where many residents were sat; during a 15-minute period in the afternoon there was no permanent staff presence, as the manager later indicated there should have been, with staff popping in and out; during this time one disorientated resident approached another six times, much to this residents frustration, staff did not see this and were therefore unable to intervene. Lymewood Nursing Home DS0000061709.V273912.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38 The home is properly organised and run in the best interests of residents, by an experienced and competent manager. Systems are in place to help keep the home safe but arrangements to minimise the risk of fire need to be improved. EVIDENCE: The Registered Manger is a very experienced Registered General Nurse having cared for people who have Dementia for many years. She informed the inspector that she has an “Introductory Diploma in Management” and has forward copy of her certificate to the commission. Staff spoken with described her as approachable and supportive; she was seen to have a warm rapour with residents and the visitor who met the inspector spoke highly of her. Lymewood Nursing Home DS0000061709.V273912.R01.S.doc Version 5.1 Page 18 Throughout the inspection the manager was knowledgeable about the homes residents, staff and management systems. The manager told the inspector that the home does not hold any service users money and that where small items are bought or extra service provided such as hairdressing, accounts are sent to relatives of residents with receipts. The relative spoken with confirmed that concerns and ideas are listened to and said that a regular relatives meeting is held which the owners and manager attend, and where ideas and concerns are aired. The inspector was shown a letter, which had recently been sent to all residents’ next of kin outlining the outcome of a recent quality survey and the actions that would be taken as a result. Records seen by the inspectors were generally properly maintained, with entries dated and signed appropriately. Two fire extinguishers seen had been serviced within the past year and one of the “stand-aids” seen was marked as having been serviced the previous October. Maintenance records seen showed that window restrictors and wheel chairs, amongst other items, are inspected monthly. Record of a fire officer inspection conducted only five days earlier, was shown to the inspector, this made recommendations about improving signing of fire exits and the need to update the homes fire risk assessment, the manager said this had not been fully addressed but was in hand. The inspector requested the homes electrical wiring safety certificate, the manager said that checks on the system had recently been done but unfortunately the certificate could not be found. Lymewood Nursing Home DS0000061709.V273912.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 2 Lymewood Nursing Home DS0000061709.V273912.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation Requirement Timescale for action 09/04/06 19(1)&17( The registered person must not 2)(4)Sch2 employ a person to work at the &4 care home unless he has obtained all the information and documents specified in paragraphs 1 to 7 of schedule 2 (previous timescale of 05/10/05 not met) 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 OP12 Good Practice Recommendations It is recommended that further work is done to provide stimulation for residents that reflects their interests and capacity to take part. All staff should receive training to ensure that they would recognise if a resident were being abused and to ensure that they know how to respond, in line with the homes policies and procedures, if they were concerned that a resident was being abused. DS0000061709.V273912.R01.S.doc Version 5.1 Page 21 2. OP18 Lymewood Nursing Home 3 4 OP19 OP26 The door alarms should be adjusted/changed to minimise their negative impact upon the homely atmosphere. There should be clear written procedures for the handling of laundry. Foul Laundry should be washed at appropriate temperatures (minimum 65oC for not less than 10 minutes) to thoroughly clean linen and control the risk of infection. 5 6 OP27 OP30 Staff should be deployed to ensure residents receive the support and supervision they need. All staff should receive training, which ensures they understand the experiences and needs of people with Dementia and enduring mental health problems. The homes fire risk assessment needs to be updated and fire exit signs improved, in line with fire officer advice. Evidence that the homes electrical wiring has been checked and found to be safe, within the last five years, should be forwarded to the commission. 7 OP38 Lymewood Nursing Home DS0000061709.V273912.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 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 Lymewood Nursing Home DS0000061709.V273912.R01.S.doc Version 5.1 Page 23 - 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. 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