CARE HOME ADULTS 18-65
Lyndale Lyndale 24 Southbank Close Hereford Herefordshire HR1 2TQ Lead Inspector
Christina Lavelle Unannounced Inspection 21st November 2005 1:30 Lyndale DS0000055244.V267596.R01.S.doc Version 5.0 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 Lyndale DS0000055244.V267596.R01.S.doc Version 5.0 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. Lyndale DS0000055244.V267596.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Lyndale Address Lyndale 24 Southbank Close Hereford Herefordshire HR1 2TQ 01432 378118 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) Lyndale (Hereford] Limited Mrs Julie Lyn Mogg Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Lyndale DS0000055244.V267596.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Additional Conditions 1. Residents may also have a physical disability or a mental disorder in addition to a learning disability. 2. That the registered manager must undertake training and achieve a qualification in management and care at NVQ Level 4 by 31st December 2005. 3. That the registered manager must undertake training in fire safety and in relation to general health and safety matters (including risk assessments) to a management level by 31st December 2005. 13th May 2005 Date of last inspection Brief Description of the Service: Lyndale provides accommodation and personal care for eight adults (men and women) aged up to sixty-five. Service users must need care due to learning disabilities. They may also have a physical disability or a mental health problem that is linked with their learning disability, including epilepsy. Service users may also use behaviours which can be challenging to a care service. The home is a large detached Victorian house in a quiet residential cul-de-sac. It has some parking spaces at the front and a large, secure garden to the rear. There is also a small enclosed courtyard area which can be accessed from the kitchen and has patio tables and chairs. Lyndale is a short walking distance from Hereford city centre and so the shops and facilities can be reached easily. The bedrooms in the home are single and all but one are on the first floor. Two bedrooms have en-suite facilities. There is also a self-contained flat on the ground floor for one person with a kitchen/sitting area, bathroom and bedroom The home has two lounges and a separate dining room on the ground floor and bathrooms/toilets on both floors for all the service users to use. There is also a laundry room and office. Lyndale DS0000055244.V267596.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This routine unannounced inspection was carried out in less than three hours on a Monday afternoon in the autumn. The main aims were to check if action had been to address issues arising from previous inspections and to obtain a snapshot of life at the home. The way the home is run, service users’ care and staffing were discussed with the manager. Time was spent with staff on duty and service users and three service users were spoken with individually about their lives at Lyndale. Comment cards were left at the home for service users, their relatives and visitors and professionals who have contact with the home, asking for their views of the service. Some of the feedback is referred to in this report. Various records about service users’ care, staff and how the home is kept safe were checked. Some parts of the house, food stocks and the menus were looked at. Communication from the home to the Commission since the last inspection (such as about events and reports on the home made by the provider following their required monthly visits) was taken into consideration. What the service does well: What has improved since the last inspection?
Work had continued to make the house nicer for service users. One sitting room had recently been redecorated and refurnished and shower facilities on the ground floor were being replaced so they were better for service users.
Lyndale DS0000055244.V267596.R01.S.doc Version 5.0 Page 6 The way that medicines in the home are handled had been improved and made safer. This was following advice from a specialist Pharmacist inspector. Staff were now doing training that is especially for those who work with people who have learning disabilities. This should give them the understanding and knowledge they need to do their job well. It is also a basis for NVQ training, which is a qualification that all care workers should obtain. The home had also arranged for staff to do more health & safety training and to attend training sessions so they know how to respond in a positive way when service users use behaviour that is unsafe for themselves or other people. The manager was making progress to obtain an NVQ qualification in care and management. She had also recently completed an in-depth health & safety course. This training should help her to manage the home more effectively and to protect the health, safety and welfare of service users and staff better. 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. Lyndale DS0000055244.V267596.R01.S.doc Version 5.0 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 Lyndale DS0000055244.V267596.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These Standards were not assessed as no new service users had been admitted since the last inspection and there were no vacancies at this time. It was previously confirmed that the home provides appropriate information. However for prospective service users the service users’ guide and terms & conditions of residence documents had needed to be in a more suitable format, which people with learning disabilities would be more likely to understand. Lyndale DS0000055244.V267596.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6&9 A good “person-centred” care planning system was operated so that service users’ needs and goals were identified and staff knew how to meet them. A risk assessment process also helped to minimise any risks to service users’ health, safety and welfare. EVIDENCE: One service user’s care records were checked. Staff had appropriately carried out an assessment and reviews of their care needs. Plans had been drawn up showing the help needed from staff to meet their needs and how to manage any risks. Risk assessments covered relevant areas, such as diet and eating, bathing, moving & handling and there was an individual policy for aspects of this person’s behaviour that may require staff intervention to keep them safe. Keyworkers were allocated to service users from the staff team. They had undertaken monthly reviews of service users’ care needs (with them whenever they could) and updated their plans accordingly. Two service users knew who their keyworker was and had an understanding of their role and responsibilities and said they valued their input. A keyworker system can make the support given to service users more personal and because care staff are more likely to know service users better can ensure their own goals and wishes are known.
Lyndale DS0000055244.V267596.R01.S.doc Version 5.0 Page 10 The manager had arranged to receive a briefing from the local co-ordinator for person centred care planning (PCP). This could be of benefit to service users as PCP focuses on service users’ wishes and individual needs and goals. Whilst the home’s care planning does currently involve service users this could further develop their system as well as forge links with other professionals to ensure that the home’s practice is in line with currently accepted guidelines. Although not reviewed in this inspection some aspects of the management of challenging behaviour were discussed with the manager. Care homes should all have relevant general policies and procedures in place as well as individual management plans. Whenever any form of physical intervention might be needed procedures should be in line with Department of Health guidance. This guidance also states that training for staff relating to physical interventions should normally be from a BILD accredited source. Lyndale DS0000055244.V267596.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 14 & 17 Staff enabled service users to lead active and interesting lives and to take part in a variety of activities to develop their social and life skills. Service users received a balanced diet, taking into account their preferences and special needs. Meals were arranged flexibility to fit in with their lifestyles. EVIDENCE: Staffing was arranged flexibly to facilitate service users’ activities and outings to ensure they were occupied as they wished. There were college tutors at the home today and some service users went out shopping into town. The tutors confirmed they worked closely with the home; that they felt staff understood service users’ needs and they were able to see service users in private. Staff continued to seek more opportunities for service users to participate in social and developmental activities within the community. This included courses run by ECHO and through local colleges and Workmatch. For service users capable there was a focus on them developing their social and life skills.
Lyndale DS0000055244.V267596.R01.S.doc Version 5.0 Page 12 Some service users now went to a pottery class, attended Monday club for people with learning disabilities and one person was doing a Gateway life skills award. One service user had recently started a work placement at the leisure centre for a couple of hours a week. Various college courses had been taken up, including literacy, numeracy and cooking. Tutors from a local college continued to provide in-house sessions for such as arts, crafts and music. The home has vehicles for outings futher afield. Several service users had recently been on holiday to Porthcawl in a caravan. One service user spoke very positively about his life at Lyndale. He had been encouraged by staff to go out more and be more independent in respect of his personal care and self-determination. This had enabled him to consider the possibility of moving on at some point to a more independent living setting. Although Standard 15 on relationships was not fully reviewed the feedback from five relatives’ comment cards was that they were satisfied with the overall care provided. They all also indicated they were made welcome in the home and kept informed and consulted about their relatives’ care. The food provided by the home was shown in a 4 week set menu and any alternatives chosen or needed by individual service users were also recorded. This reflected a varied and wholesome diet that included such as wholemeal bread and cereals, yoghurts, fresh fruit and vegetables (seen today). Today’s meal was a tasty stew with various vegetables. Staff and service users confirmed service users’ food preferences and special dietary needs were taken into account and meals were taken as best suited them, to fit in with activities. Lyndale DS0000055244.V267596.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 & 19 Suitable arrangements were in place to meet the personal and health care of service users. EVIDENCE: Service users were observed to be well presented and appropriately clothed. Plans detailed the assistance needed from staff to ensure their physical needs are met and good hygiene maintained There was evidence in service users’ care records that staff monitored and reported on service users’ mood, behaviour and health. The plan seen included such as dietary needs and exercise as ways of promoting good health. Records also showed regular input was obtained from health care professionals e.g. a Psychiatrist, Counsellor and Speech Therapist. It was good that action had been taken to deal with matters relating to medication in the home, which had been raised in an inspection carried out in June by a specialist Pharmacist inspector. The home’s response to this inspection had been thorough, although it was reported that at the time there was already a sound basis for the management of medicines in the home. All staff involved with administering medicines had previously had training relating to the monitored dosage system used by the home. This was being extended to a safe handling of medicines session, covering all relevant areas
Lyndale DS0000055244.V267596.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Although these Standards were not fully assessed it was discussed with the manager that it is strongly recommended for staff to receive training from the local Adult Protection co-ordinator. Whilst the home’s induction training does cover abuse and adult protection issues this additional training would ensure staff are clear about the local multi-agency procedures for the Protection of Vulnerable Adults. So reiterating their responsibility to report any suspicion or incidence of abuse or neglect of service users and how and whom to refer to. It was previously confirmed the home provides a suitable complaints procedure that was operated effectively. However two relatives commented they were unaware of the procedures, although they also indicated they had never had to make a complaint. Whilst there was evidence that any concerns raised by relatives are dealt with appropriately the home should ensure families are reminded about the home’s procedures, perhaps at reviews or be sent a copy. Lyndale DS0000055244.V267596.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Lyndale provides suitable accommodation to meet service users’ needs. The accommodation is of very good quality and effective arrangements were also in place to maintain, keep safe and continually improve the physical environment. EVIDENCE: Although these Standards were not fully assessed the home is conveniently located and it was previously confirmed it provides suitable accommodation for service users. The house is secure, homely and comfortable and the areas visited were warm, clean and tidy. The bedrooms seen were well personalised. There were no safety hazards identified today and it was good that one sitting room had recently been redecorated and refurbished. There was work ongoing to provide better ground floor shower facilities. The home provides policies and procedures relating to infection control and the evidence indicated that staff maintained a good standard of hygiene. Lyndale DS0000055244.V267596.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Suitable staffing levels were maintained and progress being made to ensure that all staff receive appropriate training to help them understand and do their jobs better. Thorough recruitment procedures help to ensure that only suitable people work at the home and for the protection of service users. EVIDENCE: The evidence obtained from the manager, staff and rotas indicated staffing levels were sufficient to meet service users’ personal care and social needs. Relatives also expressed their view there were always sufficient staff on duty. There were three staff vacancies currently and a support worker was “acting up” currently for the one team leader post. As the home employs four regular relief staff there had not been any need however to deploy agency staff whilst new staff are recruited. This is positive for consistency of care. All staff were expected to complete Learning Disability Accredited Framework (LDAF) induction and foundation training. This training is specifically for staff working with people with learning disabilities and provides the knowledge base for an NVQ qualification in care. Lyndale DS0000055244.V267596.R01.S.doc Version 5.0 Page 17 Although only two staff had achieved an NVQ qualification to date a number of other staff were doing this training currently. As the Standard specifies that at least 50 of staff in care homes should have this qualification the programme of NVQ should continue as a matter of priority. The records of a new staff member were checked. The home appropriately had taken up two written references (one from their last employer) and a CRB/POVA check for this person before they were appointed. They had also been required to sign a confidentiality statement and a health declaration as part of their application and/or induction. Lyndale DS0000055244.V267596.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: None of these Standards were fully assessed, although the following information is relevant to the safe and effective management of the home. The management arrangements had not changed since the last inspection. The home’s registration includes two conditions relating to the manager (Mrs Mogg’s) training. Mrs Mogg confirmed she is progressing towards achieving an NVQ level 4 qualification in management and care. She had also completed an in depth health & safety course and had already passed the written assignment and was awaiting the result of an examination. Mrs Mogg confirmed her intent to arrange to attend a fire safety management training session in due course. The manager reported that the home received good support from the provider and that she and the deputy manager had regular individual supervision. Lyndale DS0000055244.V267596.R01.S.doc Version 5.0 Page 19 The manager confirmed that most staff had now completed all the mandatory health & safety training topics i.e. first aid, food hygiene and moving & handling and that fire safety sessions had been arranged. Senior staff had also completed a First Aid at Work training course. There were no heath and safety hazards identified today and other relevant aspects checked and/or seen were as follows: • • • • • A risk assessment checklist had been completed for all areas of the premises. Annual PAT (portable electrical appliances testing) was recorded as having been carried out. Window restrictors were n place and recorded as having been checked. Shatter proof film had been placed on windows. The fire log showed that tests and checks on the fire safety system and equipment were recorded as having been carried out at the specified intervals. Also that fire drills were arranged as required. Lyndale DS0000055244.V267596.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 3 12 3 13 X 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 X 3 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Lyndale Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000055244.V267596.R01.S.doc Version 5.0 Page 21 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. Standard 1 YA42YA3 7 Regulation 9 Requirement The manager must undertake training in fire safety and general health & safety (including risk assessment) to a management level. This is a condition of the home’s registration and previous timescales had been set. Whilst only confirmation is needed for sucessfull completion of a general health & safety training course the manager had yet to do the fire safety training. The timescale is again extended . The manager must achieve an NVQ level 4 qualification in management and care. This is a condition of the home’s registration and has had previous timescales for completion. Whilst progress has been made there have been issues with the training body. Hence the timescale is extended. Timescale for action 31/03/06 2 YA37 9 31/03/06 Lyndale DS0000055244.V267596.R01.S.doc Version 5.0 Page 22 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 YA23 Good Practice Recommendations It is strongly recommended that all staff should receive training in relation to abuse and procedures from the local co-ordinator for the Protection of Vulnerable Adults. Lyndale DS0000055244.V267596.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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