Inspection on 13/08/07 for Lyndale

This inspection was carried out on 13th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lyndale 15/01/09

Lyndale 08/01/08

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Lyndale 2 Alumdale Road Westbourne Bournemouth Dorset BH4 8HX Lead Inspector Jo Pasker Key Unannounced Inspection 13 , 17th, 22nd & 28th August 2007 10:00 th DS0000069815.V342599.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000069815.V342599.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000069815.V342599.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lyndale Address 2 Alumdale Road Westbourne Bournemouth Dorset BH4 8HX 01202 764425 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) Purple Care Ltd ****Post Vacant**** Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9) of places DS0000069815.V342599.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary needs on admission to the home are within the following category: Mental Disorder, excluding learning disabilities and dementia (Code MD) The Maximum number of service users who may be accommodated is 9. New service-first inspection. 2. Date of last inspection Brief Description of the Service: Lyndale is registered as a care home providing residential care for up to 9 people under the age of 65 years old, who are experiencing mental health problems. The home is located in a residential area of Westbourne within a short walk to the beach and close to the community facilities of Westbourne. Local bus services are good and link to both Poole and Bournemouth town centres. Lyndale is an older style, detached house with a large garden for residents’ use to the rear. Accommodation is provided over two floors with 4 single rooms (3 with en-suite) and a shower room on the ground floor and 5 single rooms all with en-suite and a bathroom, on the first floor. Communal areas on the ground floor consist of a large open lounge and dining area and a shared kitchen. Car parking is available directly outside the home or in the surrounding roads. Purple Care Ltd owns the home and the Registered Provider is Mrs Miljana Kiss. The home is currently without a Registered Manager but does have an acting manager in place that oversees the day-to-day running of the home. The fee prices in August 2007 range from £430 to £900 per week for residential care. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk and the following website offers further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_c hoos.aspx DS0000069815.V342599.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 4 days-the 13, 17, 22 and 28 August 2007 and took approximately 9 hours. The purpose of the inspection was to assess all of the key standards for the first time in the home since it had been bought and newly registered by Purple Care Ltd. The acting manager at the time was on hand to aid the inspection process and was very helpful throughout and feedback was provided to the Registered Provider, Mrs Miljana Kiss on the final day of the inspection. Information for this report was obtained from discussion with the acting manager, Registered Provider, discussions with 5 service users and 2 members of staff on duty, a review of a variety of documentation including records provided to the Commission, care records, staff records, maintenance records, policies and procedures and a guided tour of the home. The annual quality assurance assessment (AQAA) sent before the inspection had been completed and returned and a total of 8 comment cards from residents, GP’s and care managers were also received. What the service does well: The home’s pre admission procedure is good and prospective residents are provided with information about Lyndale and are encouraged to visit, in advance of admission, to establish their impressions of life at the home and the standard of available accommodation. Individual plans and risk assessments are detailed, person-centred and informative ensuring residents and staff are fully aware of how needs and goals are to be met. People are able to make a range of choices about their daily lives. Residents are supported and encouraged to participate in activities, which interest them, to be part of their local community and to maintain links with family and friends so that they have networks of support outside of their home. Daily routines in the home promote residents’ independence and there is a flexible approach to mealtimes, which promotes residents’ well-being and enjoyment of their meals. Access to generic and specialist health care services ensure that residents’ physical and mental health care needs are well met. Lyndale provides a homely environment in which to live and meets the needs of the residents. DS0000069815.V342599.R01.S.doc Version 5.2 Page 6 Fire training, fire safety procedures and appliance servicing is up to date. 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. DS0000069815.V342599.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000069815.V342599.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with information about Lyndale and are encouraged to visit, in advance of admission, to establish their impressions of life at the home and the standard of available accommodation. EVIDENCE: There have been no new admissions to the home since Lyndale was registered with the current owner in May 2007. Therefore this standard has not been able to be fully assessed at this inspection. The acting manager clearly discussed the process of admission and was knowledgeable about what pre admission practices were necessary to ensure that individual’s needs were accurately assessed and whether the home could meet these needs. All of the residents that responded to the survey indicated that they were asked if they wanted to move to the home and that they had received enough information about Lyndale before they moved in, in helping them decide that it was the right place for them. Comments included “I was very pleased to get a single room at Lyndale because I had had to share for quite a while” and “I was told about this home and I visited for tea quite a few times”. DS0000069815.V342599.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individual plans and risk assessments are detailed, person-centred and informative ensuring residents and staff are fully aware of how needs and goals are to be met, however the home needs to evidence that these are being put into practice and ensure records are accurately documented. People are able to make a range of choices about their daily lives but these may be hindered by staff availability. EVIDENCE: The individual plans of 2 residents were seen. Both contained detailed information on aspects of personal and social support, healthcare needs, leisure activities and independent living skills. However, the home is implementing new paperwork based upon ‘goal planning’ which is more relevant to the residents and their needs within the home yet both old and new styles were found in the file which made it confusing to read. DS0000069815.V342599.R01.S.doc Version 5.2 Page 10 The files did not contain photographs of the residents, as required, although the acting manager confirmed that the Registered Provider had taken them. Some residents had refused, but this had not been documented in the files. The plans clearly included resident’s own personal goals, such as “I need support to attend a gym or swimming pool until I am confident to attend alone” and “to build on food preparation skills”. There were also detailed support plans written that described the actions needed by staff on a daily basis to ensure that residents’ needs were met. However, many goal plans were not dated or signed by the resident or staff to evidence that they had discussed and agreed them and there was no written evidence of any reviews taking place despite the acting manager confirming that they had happened. There was also little documented evidence in the daily entry notes of staff addressing individuals’ goals despite it being clear from discussion with staff, that they were very aware of individual’s needs and actions required. One resident’s goal plan described how they were to cook 1 afternoon each week with a member of staff supervising, yet over several weeks only 1 entry was found stating that this had taken place. Observation during the course of the inspection showed good examples of residents being supported to make their own decisions such as making their own meals, choosing to eat when it suited them and going out at different times of the day. Residents confirmed through discussion and comments made in the surveys that they are able to do what they want to during the days, evenings and weekends. Residents are allocated a key worker that they get on with and regular residents meetings are held where they have an opportunity to have a say in the running of the home. All but 2 of the residents manage their own money and there are risk assessments in place for how they manage their finances. Evidence confirmed that risk assessments were in place for many tasks including taking medication, food preparation, managing budgets and finances and the misuse of alcohol and illicit substances. However there was no evidence of some of these having been dated, signed or reviewed. Residents spoken with felt that they are enabled to be as independent as possible in their home and community but felt that staffing issues sometimes affected this ability. This was also echoed by responses to the care managers’ survey, which stated that they felt there should be more staff to support practical life skills, so that residents can access their local area independently. DS0000069815.V342599.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported and encouraged to participate in activities, which interest them, to be part of their local community and to maintain links with family and friends so that they have networks of support outside of their home. However the home must ensure that staffing levels do not impact upon residents’ opportunities. Daily routines in the home promote their independence and there is a flexible approach to mealtimes, which promotes residents’ well-being and enjoyment of their meals. EVIDENCE: Information supplied by the Registered Provider in the AQAA indicated that residents take part in a range of activities in their local community. This includes attendance at various day centres, social clubs, swimming and a gardening project according to personal preferences. Weekly programmes of individuals’ attendance were seen in their personal files and in discussion, DS0000069815.V342599.R01.S.doc Version 5.2 Page 12 residents confirmed that they attended different activities throughout the week, with one person attending a voluntary work placement. Comments received reflected that they chose what to do including “I do a lot of physical exercise in my room” and “I go home at weekends”. Residents confirmed that they access the community on a regular basis, for example, visiting local parks, pubs, town centre and the supermarket but this was not always well documented in the entries by staff in their daily notes. Some people also felt that their choice of activities was sometimes restricted by staffing levels and there was little opportunity for spontaneous trips out, such as to the pub. Many residents use the local bus service independently and the AQAA provided by the Registered Provider stated that transport was also provided for medical appointments, meetings with healthcare professionals and for social activities and the gym. However, the home does not have a dedicated vehicle for the use of residents and staff spoken to confirmed that they, or a care manager, frequently used their own cars to transport residents to and from different places. Residents spoken with reported that they maintain links with members of their family through visits and telephone calls and it was observed during the inspection that relatives were welcomed in the home at any time. A payphone in the home was situated in the hallway, however this had a notice on it during most of the inspection stating it was out of order yet residents were free to use the office phone when needed. Observation during the inspection showed routines in the home were flexible with residents able to choose whether to spend time in the communal areas or opting to be alone in the privacy of their rooms. All residents are encouraged to participate in aspects of maintaining the home environment in terms of helping with cooking and doing household tasks with assistance from staff, however some residents chose to participate more than others. The AQAA states that residents are involved in discussing the planning and preparation of meals during residents’ meetings and some evidence of this was seen in the minutes of the meetings. Menus were displayed on a board in the kitchen and adequate supplies of food were seen in the kitchen with the weekly shopping seen arriving one day. People reported that the food at Lyndale is good although one resident stated that at times the menu lacks variety. Residents reported that on occasions they go out for lunch and often have take-away meals in the evenings, which they enjoy. Residents can access the kitchen as they choose and there was evidence of individuals choosing what to eat at lunchtime during the course of the inspection. DS0000069815.V342599.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The majority of staff have a good understanding of residents’ care needs and support is offered in a way that promotes independence and respects personal preferences. However staffing levels and staff language differences may, at times, have a negative impact on the support offered to residents. Access to generic and specialist health care services though, ensures that residents’ physical and mental health care needs are well met. Further development of medication procedures and training is needed to ensure that people are fully protected by practices within the home. EVIDENCE: 2 residents’ individual files were looked at and both documented their personal care needs and the support they require. The majority of residents at Lyndale can manage their personal care independently with staff providing advice and prompting when necessary. Only 3 out of the 6 respondents to the survey indicated that they could ‘always’ make decisions about what they did each day, with the others indicating that this was ‘sometimes’ the case. DS0000069815.V342599.R01.S.doc Version 5.2 Page 14 Discussion with residents confirmed their personal care needs were mainly met when required and they had choice over their daily routine to an extent but this was limited by staffing issues at times. Comments from residents received via surveys and through discussion indicated that while they speak highly of the competence of the majority of staff who work with them, some staff do not always understand their needs due to language difficulties. Some residents also felt that they were sometimes unable to attend certain activities due to a lack of staff numbers. Comments included “I have fairly routine weeks but I can decide exactly how to carry this routine out”,” Some staff don’t understand us very well” and “I get out when I want to but not as often as I used to”. Discussion with staff though, demonstrated they had a good understanding of residents’ individual needs and their likes and preferences and this was also observed over the course of the inspection. All residents living at Lyndale had personal health care records which documented visits to the GP, chiropodist, dentist and contact with other healthcare professionals such as care managers and psychiatrists. It was observed that the acting manager quickly acted in contacting a resident’s community mental health team (CMHT) when there were concerns about changes in their mental health needs. A care manager responding to the survey also reflected this, indicating that individuals’ health care needs are ‘always’ properly monitored and attended to by the care service and commented that the home “Monitor both physical and mental health closely and arrange appointments as appropriate”. Medication is kept in a locked metal cabinet in the office which all staff have access to. The home uses a monitored dosage system for most medicines and a record of administration was seen. There were no gaps in the records, allergies were listed or ‘not known’ documented, all abbreviations were listed and used appropriately and an up to date staff signature list was also seen. 2 residents were being supported to manage their own medication at the time of the inspection yet no risk assessments by the home could be found within their files. 1 resident’s individual plan stated that they were to receive 2 days worth of medication at a time to self medicate, but it was unclear in the daily entries when this took place. On the day of inspection all of these medicines had already been signed for on the medicine administration record (MAR) chart despite the fact that some were not due to be taken until that evening. Staff were also dispensing the medicine of another resident from the original pharmacy box into a dosette box, which was then being given to the resident at the required time by whichever staff was on duty. The amounts of medicine supplied and dispensed did not add up, there was no carry forward amount or date received on the MAR chart and the amounts were written in the home’s general communication book each week instead. (The home has since confirmed that they no longer use this system and have taken advice from the DS0000069815.V342599.R01.S.doc Version 5.2 Page 15 Commission’s local pharmacy inspector, which has been implemented and who will be visiting the service to further assess all medicine handling and administration procedures). Hand written entries were neither signed by 2 competent people nor dated and the reasons for administering medicines prescribed ‘as required’, were not documented on the MAR charts or in the individual plans. The home’s training records stated that most staff administering medicine had received some training in the safe handling of medicine but not all staff files showed evidence of this. DS0000069815.V342599.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are procedures in place to ensure that complaints are fully investigated and residents are given an opportunity to raise any concerns. However, improvements to communication between staff and residents are needed to ensure that residents feel that their views are listened to and acted on. Policies, procedures and training are in place to protect residents from abuse and ensure that they are safe with the people who work with them but better records need to be kept to evidence training. EVIDENCE: The home has a clear complaints procedure in place and a copy of this is on view in the hallway. The Commission has received no complaints, however there has been 1 complaint made to the home. This was investigated and appropriate action taken, with all outcomes clearly documented in the complaints book. All residents responding to the survey indicated that they knew who to speak to if they were not happy, with 1 resident commenting “I know who my key worker is and get on well with her”. 5 out of the 6 respondents stated that they knew how to make a complaint and commented, “I can complain to any member of staff”. Residents’ meetings are held on a regular basis and the minutes of the last one held in August 2007 were seen. 4 out of the 6 residents replies to the survey indicated that their care workers always listened to them and acted on what they say with 1 stating that this was ‘usually’ the case and 1 stating it was DS0000069815.V342599.R01.S.doc Version 5.2 Page 17 ‘sometimes’ the case. One commented that “The staff are very helpful and listen to what you say” whilst another felt that the staff were sometimes too busy with others to listen to them. There is a policy in place on adult protection and the prevention of abuse and the home’s AQAA states that there is also a whistle blowing policy in place. The manager confirmed that 1 member of staff had recently received adult protection training and the certificate was seen and that 2 more staff members were due to attend training from the local authority next month. The home’s training records stated that most staff had received some adult protection training but not all staff files showed evidence of this. The home has now signed up with an umbrella organisation to ensure that the appropriate checks are carried out on staff, prior to employment, to determine their suitability to work with vulnerable adults. DS0000069815.V342599.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Lyndale provides a homely environment in which to live and meets the needs of the residents. The home is generally clean and well maintained however a review of cleaning and the relevant policies and procedures is recommended to ensure that the home remains in good order, good hygiene practice is maintained and that residents are protected from infection. EVIDENCE: A tour of the premises found the home generally clean and well maintained however the front outside area of the home appeared neglected and the garden overgrown and the shower room on the ground floor was seen to have mould on the ceiling. Otherwise, all areas were seen to be clean and well maintained providing a suitable and comfortable living environment for the residents. New sofas, a dining table and a large television have replaced the existing ones and the décor in the lounge area has been updated. A new kitchen has also been fitted but at the time of inspection was still awaiting DS0000069815.V342599.R01.S.doc Version 5.2 Page 19 some more unit doors to be fitted. From speaking with residents in their rooms, it was evident that they are able to personalise their bedrooms to their own tastes and the majority of rooms have en-suite facilities. The laundry room appeared clean and tidy and contained adequate facilities for the residents. 4 out of 6 residents responding to the survey indicated that the home is ‘always’ fresh and clean, with 2 indicating that it is only ‘usually’ clean. The home has an Infection Control policy in place, which was last reviewed in 2006 but it is unclear whether it has been updated to include recent guidance provided by the Department of Health. DS0000069815.V342599.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels are adequate although do not reflect the gender mix of the residents and consideration should be given to increasing staffing at times to enable more residents to participate in activities of their choice. There is no comprehensive training plan in place, skills are variable and inadequate specialist training for all staff means that needs may not always consistently be met. Recruitment practices do not sufficiently ensure that residents are protected from potentially unsuitable staff. EVIDENCE: The home currently employs 7 members of care staff who have a range of skills and experience. At present all are female staff and most have previous experience of working in social care. The AQAA submitted, states that there are currently 6 members of staff who hold a qualification of NVQ level 2 or equivalent but only 1 staff file contained evidence of this. The staff rota was observed and showed that the home was staffed 24 hours a day, usually with one member of staff on duty, apart from the mornings when the acting manager was also on duty and the evening shift from 6pm-10pm when 2 members of staff worked. DS0000069815.V342599.R01.S.doc Version 5.2 Page 21 Staffing levels are determined by the number of residents in the home and an assessment of their needs at the time. However it was evident that further staffing hours should be considered to enable residents to participate in more activities of their choice. The acting manager and the Registered Provider are both on call if needed also and a lone working policy is in place within the home to provide guidance to staff on maintaining their own safety and that of others. The files of 3 staff members were viewed during the inspection. The following shortfalls were seen: • In 1 staff file there was only evidence of 1 reference, there were gaps in their employment history and no evidence that these had been explored at the time of interview. There was also no evidence to support that the home had requested a statement by the person as to their physical and mental health, ensuring they were fit for the job. In another file there were also gaps in employment history and no statement of physical and mental fitness for the post. The third file did not contain any proof of identity or evidence of the membership of a professional body (which was applicable to that employee). • • All other necessary documentation was present. The acting manager is using the Skills for Care common induction standards to induct all new staff and evidence of this was seen along with a first day induction checklist. The acting manager was unable to provide a staff training matrix e.g. a list of staff and what training they have done and when they are due for training refreshers, however there were lists for individual staff. Some of the training documented could not be evidenced by certificates but all fire training was seen to be up to date. It was unclear whether other mandatory training had been completed. Some members of staff are also attending English language classes as it is not their first language and concerns have been raised by the home, residents and other professionals about difficulties experienced with communication and whether residents’ needs are being fully met. Discussion with staff demonstrated that they have an understanding of residents’ basic needs but there was concern that some staff may not have the necessary skills or fluency of language to meet the specific needs of service users. Further information on available training can be accessed through the following websites: www.picbdp.co.uk www.skillsforcare.org.uk DS0000069815.V342599.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home currently lacks clear leadership, management arrangements are weak and improvements are needed to ensure that the home is run in the best interests of residents. The home has a quality assurance strategy based on seeking the views of residents and others but needs to demonstrate how feedback is incorporated into the development of the service. Shortfalls in some aspects of health and safety practice and training within the home means that residents may be put at risk. EVIDENCE: The home does not currently have a Registered Manager although an acting manager was in place at the time of the inspection who had responsibility for the day-to-day running of the home. However, the Registered Provider has since informed the Commission that this manager has now resigned and a temporary acting manager put in place. DS0000069815.V342599.R01.S.doc Version 5.2 Page 23 The home has not had a Registered Manager since the current Registered Provider, Mrs Miljana Kiss, has been in place. Prior to this (under the previous owner) Lyndale had not had a Registered Manager since November 2005. It is essential that the home have a suitably experienced and qualified manager in place to ensure that residents are adequately protected and safely cared for. It will therefore be a requirement in this report that the Registered Provider ensures that a Registered Manager’s application is submitted to the Commission within 6 months and the new applicant must demonstrate the appropriate skills and that they possess, or are working towards, a management qualification, which is equivalent to the Registered Manager’s Award. Dedicated supernumerary hours should also be allocated to the current acting manager, enabling all management tasks and record keeping to be maintained to a good standard. The home submitted a completed AQAA prior to the inspection detailing how they currently meet Care Standards and how they plan to improve, however some areas were not answered and the evidence to support other information could not be found during the inspection. Residents’ and healthcare professionals’ opinions are sought by the home through the use of their questionnaires, which covered areas including food, daily living, personal care and support, premises and management. However, it was not clear what actions would be taken to improve the service available to residents, based on the results. For example, 1 person stated that they would like to go on more home outings together or out for a drink or a meal but it was not clear if this had been achieved. No copy of an annual development plan was available during the course of the inspection and there was no evidence of any audits taking place. (The home has since started undertaking audits of some areas). No copies of monthly visits by the Registered Provider were available during the course of the inspection but were provided at the end. Due to the areas of concern reflected within this report and how they may affect the quality of the service for residents, a requirement has been made that the Registered Provider provides copies of these reports to the Commission so that any improvements can be monitored. Records showed evidence of weekly and monthly fire safety checks and a fire drill was recorded as having taken place in May 2007, documenting the time taken, staff involved and nature of the drill. Maintenance records seen were up to date, including electrical and gas appliance testing certificates. There was evidence on files inspected, to demonstrate that some staff had undertaken basic food hygiene training and emergency first aid training to ensure their continued safe practice in these areas but not all staff had received mandatory training. DS0000069815.V342599.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 1 X 1 X 2 X X 1 X DS0000069815.V342599.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No-first inspection 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 YA20 Regulation 13(2) Requirement The registered person must make arrangements for the safe recording, handling, safekeeping and administration of medicines within the home. Timescale for action 31/10/07 2 YA24 3 YA34 23(2)(d)&(o) The registered person must 31/12/07 ensure that all internal and external areas of the home are kept clean and well maintained. 19(1)(i) The registered person must 31/10/07 ensure that, prior to a member of staff commencing employment all the information outlined in Schedule 2 of the Care Homes Regulations 2001 is obtained. 18(1)(c) The registered person must ensure that all staff receive relevant training, including mandatory, that is relevant to caring for residents and their specific needs and a record is kept of this. The registered person must ensure that a suitable candidate’s application for the registered managers post is DS0000069815.V342599.R01.S.doc 4 YA35 YA42 31/12/07 4 YA37 8&9 31/01/08 Version 5.2 Page 26 put forward to the Commission within the timescale stated. 5 YA39 26(5)(a) A copy of the report by the Registered Provider as specified in Regulation 26 of the Care Homes Regulations 2001 must be supplied to the Commission on a monthly basis. 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 8 9 Refer to Standard YA6 YA9 YA6 YA7 YA13 Good Practice Recommendations It is recommended that goal plans/risk assessments are signed and dated to evidence when these have been agreed with residents and reviews have been carried out. Daily entries by staff in residents’ notes should reflect individual’s agreed goal plans and whether they have been achieved or not. It is recommended that a resident’s refusal regarding a copy of their photograph being kept in their file be documented. Staffing levels should be increased if necessary to provide additional support and enable residents to spend time outside of the home. When a medicine is prescribed for ‘as required’ administration the MAR should state the potential reason for administration (e.g. as required for abdominal pain). Consideration should be given to how the staff team could reflect the gender mix of residents. It is recommended that copies of training certificates be kept in staff files to evidence any training undertaken. It is recommended that the home’s annual development plan demonstrate that feedback from residents is incorporated into it. The home should provide a copy of the registered provider’s annual development plan to improve the home’s quality assurance procedure. YA20 YA33 YA35 YA39 YA39 DS0000069815.V342599.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 DS0000069815.V342599.R01.S.doc Version 5.2 Page 28 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!