Inspection on 08/02/07 for Lyndale

This inspection was carried out on 8th February 2007.

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

Other inspections for this house

Lyndale 27/01/06

Lyndale 22/08/05

Lyndale 10/11/04

Lyndale 08/07/04

Similar services:

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Chirnside House

Keer Sands Residential Home

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

CARE HOMES FOR OLDER PEOPLE Lyndale 9 Rawlinson Road Southport Merseyside PR9 9LU Lead Inspector Claire Lee Key Unannounced Inspection 09:00 8 , 9 and 12th February 2007 th th 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 Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lyndale Address 9 Rawlinson Road Southport Merseyside PR9 9LU 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) 01704 543304 01704 539226 Mr Richard Thomas Burdett Mrs Sheila Roberts Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 25 OP Maximum no. registered 25, of which up to a maximum of 25 N (nursing) and up to a maximum of 3 PC (personal care). 27th January 2006 Date of last inspection Brief Description of the Service: Lyndale is a privately owned Care Home providing twenty five registered places for nursing older people. The registered provider/owner is Mr Richard Burdett and the registered manager Mrs Sheila Roberts. Lyndale is a large detached converted house situated in a quiet residential area of Southport close to the town centre and Hesketh Park. Local amenities can be accessed by the local transport services, which are close to the home. The home has twenty three single rooms, eight with an ensuite facility and one double room. All areas of the home are accessible by the use of a passenger lift, stairs and a chairlift to the mezzanine levels (no lift access) on the first and second floor. There is a spacious attractively decorated lounge and this room is also used as a dining area. Bedrooms are of a good size and colour schemes are very pleasant. Bathrooms are well equipped to assist those who are less independent and there are handrails and a ramp to the main front door. A call system operates with an alarm facility throughout all areas. Residents are able to enjoy the homes large enclosed garden during the warmer months. The weekly fee rate is £463.50 a week for accommodation. Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over three days for duration of ten hours and twenty four residents were accommodated at this time. A site visit took place as part of the unannounced inspection and this included a partial tour of the premises. A number of the home’s care, staff and health and safety records were viewed and discussions took place with seven residents, four staff, the home’s administrator, manager and registered provider. During the inspection three residents were case tracked (their care files were examined and their views of the home were obtained). This process was not carried out to the detriment of other residents who also took part in the inspection process. Discussion also took place with one relative. All the key standards were inspected and also the previous recommendation from the last inspection in January 2006 was discussed. Satisfaction survey forms “Have Your Say About …” were distributed to a number of residents and relatives for them to complete. None have been returned to the Commission as yet however comments received from residents and relatives at the time of the site visit are included in the report. What the service does well: The home presents with a very warm, welcoming and friendly atmosphere. Residents and relatives were complimentary regarding the standard of care and support they receive. A resident said, “The staff take good care of me”. Visitors were observed popping in at various times of the day and were able to spend time with their family member in the privacy of their own room or in the lounge if preferred. A relative said, “I come in each day and am always offered a cup of tea”. Staff were observed to interact well with the residents and appeared to have sufficient time to give the necessary care and support required. Through discussion and observation it was evident that residents were treated respectfully and the home ensures good standards of privacy and dignity. Staff were observed to knock on bedroom doors before entering and giving assistance to residents with their meals in a sensitive unhurried manner. Staff were described as being “Pleasant”, “Caring”, “Friendly” and “Cheerful”. A resident said, “The staff are here to help and they do a good job”. Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 6 The manager completes a care needs assessment on all residents admitted to the home. The assessment is detailed and records the relevant care and support required by the resident. Good attention is paid to recording relevant medical history, hearing, sight, dental care and social background. The home offers a varied activities programme, however some residents do not wish to participate and this wish is respected by staff. A fortnightly reading circle is very popular and other activities include music, film shows, exercise group and flower arranging. The activities programme is displayed for residents to view. Residents were complimentary regarding the choice, presentation and quality of food. The menu is based over four weeks and offers well balanced meals. An alternative is available on request. A resident commented that staff always advise them of the choice and that the chef provides home baking most days. The home is pleasantly decorated and areas seen were very clean and odour free. Furniture and fittings are of a good standard and the home is subject to an ongoing programme of decoration. A resident interviewed was pleased with the bedroom and had personal items from home to make it more ‘homely’. The resident said, “The room is very comfortable and spacious”. As part of evaluating the care and service, residents and/or relatives are given satisfaction survey forms to complete. These are normally distributed every six months, the last ones being given out in September 2006. Six surveys were read and these highlighted satisfaction of the service. Residents interviewed said they were happy with the management of the home at this time. The home’s policies and procedures are being reviewed and staff are made aware of any changes to the documents. What has improved since the last inspection? What they could do better: Through observation and discussion with residents it was evidenced that the home provides a good standard of care however residents’ health care needs are not always recorded in sufficient detail or care plans are updated with information regarding conditions that may affect the resident’s welfare. Care plans must record all care needs. Residents’ weight should also be monitored as part of the nutritional assessment. Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 7 Although medicines were administered safely to residents during the day a number of residents interviewed stated that on occasions they do not take always take their morning medicines at the time administered. The night nurse prior to 8am conducts the morning medicine round; this has been raised as a concern at previous inspections as residents may be asleep, woken unnecessarily or decide as previously stated to leave their medicines to take after 8am. The manager must ensure the morning medicines are administered safely. It is strongly recommended that the home look to alter the time the morning medicine round is conducted as residents must also be able to decide about their health and welfare and this includes a choice as to whether they wish to receive their medications early in the morning. Four staff files were viewed for recruitment purposes. The files evidenced that the staff had been employed prior to a POVA (protection of vulnerable adult) check and/or CRB (criminal record bureau) disclosure being obtained. Staff can only start employment pending a CRB if a POVA check has been received. Other employment checks were in place however one staff member started prior to two references being received. Mandatory training is required for a number of staff. Staff require training in first aid, food hygiene and infection control to ensure they have the skills and knowledge to deal with an accident, to handle food correctly and to minimise the risk of cross infection. It was agreed that dates of training would be forwarded to the Commission. Formal abuse training should also be accessed to ensure staff are familiar with the latest adult protection guidance. A number of good practice recommendations have been made in the main body of the report regarding care practices, medicine administration, NVQ training and residents’ finances. 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. Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 8 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 Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2 and 3 The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents are provided with terms and conditions of residency and pre admission assessments help ensure that the home can meet the needs of the residents and provide the care and support they require. EVIDENCE: Although Standard 1 was not assessed on this occasion a copy of the home’s Statement of Purpose was displayed on the notice board in the hall for residents and relatives to view. Residents are provided with terms and conditions of residency. Contract details were seen for three residents, one contract was signed and dated by a relative on behalf of a resident. The two other contracts have yet to be returned. The fee rate is included in the contract and residents are made aware of any extra charges to be incurred. Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 10 Initial enquiry details are taken by the home and the manager then completes a care needs assessment for prospective residents. Three assessments were seen as part of the case tracking process. Comprehensive information was available regarding past and current medical history, nursing areas, for example, skin care, nutrition, mobility, continence, sleep pattern, mental awareness, history of falls and family/social background. Sight, hearing and dental care is assessed and the use of glasses and hearing aids recorded. A resident who has recently arrived at the home stated, “I am settling in but it is early days. The staff are very nice”. Standard 6 is a key standard to be assessed however the home provides long term care only and does not provide intermediate care Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans provide satisfactory information regarding the health care needs of the residents however some health care needs and practices need better monitoring. EVIDENCE: The care files seen were accessible for staff and residents and the information easy to read. Four care files were viewed as part of the case tracking process. Residents have a plan of care and a number seen were completed to a satisfactory standard. The care plans seen for recently admitted residents still need further detail as not all health care needs have been recorded in sufficient detail. This was brought to the manager’s attention and was being amended the week of the inspection. Recording further detail was discussed in relation to wound care, moving and handling and medical conditions that required contact with a GP and nursing intervention. This will provide more detailed information the staff require to enable them to deliver the care and support to the residents. A wound care chart would be beneficial for recording the clinical care needed for the management of wounds. Supporting care documentation is completed for assessing moving and handling, care of the skin and nutrition. Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 12 Although nutrition is monitored the staff had not recorded a record of weight for three residents who had recently been admitted and also four other care files viewed last evidenced a weight record in 2005. Residents should be weighed as part of the nutritional assessment to evidence weight gain or loss. If there is a concern the details must then be recorded in the plan of care. A number of care staff hold a senior care position and they should be encouraged to record the care they give as part of the development of this role. The manager and registered nurses undertake monthly reviews of care documents and the residents and/or relatives are approached for their consent and agreement to the plan of care. A resident interviewed stated that they could see their GP at any time and staff were quick to arrange appointments on their behalf. Care files seen evidenced a record of GP and other health professional visits, including annual diabetic review and administration of flu vaccines. Residents “The staff “The staff “The staff interviewed made the following comments regarding their care: give me good help” answer the call bell and help me with what care I need” are kind” General risk assessments area completed for the use of bed rails where a resident is at risk of falling. Protective covers are in placed to minimise the risk of injury. One resident did not wish to have a cover in place and this information had been added to the risk assessment. The home has a policy and procedure for safe handling, storage, administration and disposal of medicines. The medicine trolley is kept locked in the staff office and a list is available of staff signatures for those responsible for administering medicines. Medicines are administered from blister packs. The medicine Temazepam, which is liable to misuse, had been recorded in a separate book and its administration witnessed by a second member of staff. Medicine rounds during the day were observed to be conducted according to the home’s policy for safe administration. Three residents interviewed stated however that on occasions they do not take their morning medicines at the time they are administered. The night nurse prior to 8am carries out the morning medicine round. This has been raised as a concern at previous inspections as residents may be asleep, woken unnecessarily or decide as previously stated to leave their medicines to take after 8am. Medicines must be administered safely to all residents at this time. It is strongly recommended that the home look to alter the time the morning medicine round is conducted as residents must also be able to decide about their health and welfare and this includes a choice as to whether they wish to receive their medications early in the morning. Residents must benefit from the medication regime and in conjunction with talking with residents, advice should also be Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 13 sought from the home’s pharmacist and residents’ GPs as to the times medicines are to be administered. If a resident wishes to receive medicines early in the morning this should be included in their plan of care. The manager stated that medicine awareness training is being arranged by the end of March 2007 for the registered nurses. The record of medicines returned to the home’s pharmacy was viewed and the record was up to date. Staff were observed assisting resident with their meals in a sensitive and respectful manner and also knocking on private doors before entering. Communication was found to be good between staff and residents and a resident said, “The staff are always polite and helpful”. Residents interviewed were dressed in clothes of their own choice and female residents had matching accessories. Staff interviewed stated that privacy and dignity are discussed during the induction and the manager expects high standards at all times. Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to exercise choice and control over their lives and are offered a choice of well balanced and nutritional meals. EVIDENCE: The home had a pleasant atmosphere and visitors were seen popping in at various time of the day. A relative said the staff were welcoming and very attentive. Visitors to the home can use the lounge or visit their family member in the privacy of their own room. Residents’ choice regarding the time of the morning medicine round has been discussed under Standard 9 of this report. Residents spoken with were generally happy regarding the home’s routine, for example, time of getting up in the morning, retiring at night, times meals are served, time allocated for assistance with bathing. One resident wanted to talk with the manager regarding the time staff she receives assistance in the Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 15 morning and this was passed to the manager for her attention. Staff interviewed confirmed that residents could have a rest on their bed when they want and receive visitors at any time. A number of residents attend church and Holy Communion is offered at the home to enable them to continue to practice their faith. The home offers a good activities programme, which is displayed for residents to view. A resident spoke favourably regarding the reading group and was aware of the other social arrangements on offer. The home provides musical entertainment, film shows, trips out (barge trips, theatre shows, pub lunches and restaurant/show) during the warmer weather, manicures, exercise group and flower arranging. The hairdressing visits regularly and the home has a chiropody service. Some residents prefer to stay in their own room and a resident confirmed that this is never a problem. Staff were observed spending time on a one to one basis with residents in the lounge and/or in their bedrooms. Resident meetings are held and preferred activities are suggested at this time. Residents can take care of their own money if they wish and the home supports those who require assistance. Invoices are sent to the residents and/or their relatives each month for any extra charges incurred and personal allowances are given to the residents by the administrator. Finances are discussed further under Standard 35. The home offers a four week menu and residents were generally pleased with the choice, presentation and quality of the meals. A resident was celebrating her birthday with a birthday cake and staff were singing ‘Happy birthday’. The menu appears to be varied and home baking is available. The chef provides some training in food hygiene for those staff who undertake kitchen duties in preparation for the basic food hygiene course. The kitchen was tidy and clean and environmental health records seen were up to date. An environmental health inspection was conducted in January 2007 and recommendations made have been met. The home had a good supply of fresh, frozen and dry goods. Residents said, “The food if really good and there is always a choice”. “The food is very good and I get diabetic food.” A relative said, “I have a salad on a Sunday and it is always nice”. The meals are nicely presented on food trays with flower arrangements. The chef makes a note of any meals returned and advises the manager of this information. Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives have confidence that their concerns will be dealt with. Abuse policies and procedures are in place to protect the residents. EVIDENCE: The home’s complaint procedure is on display and residents and relatives interviewed were satisfied with all arrangements in the home and were aware of how to make a complaint if needed. The complaint log was seen and no complaints have been received. The manager was advised that it is good practice to also record any incidents or concerns that arise. A staff member said she would always report a complaint to the nurse in charge or to the owner. The home has an abuse policy however Sefton’s Guide to the Protection of Vulnerable Adults could not be located. The latest copy should be obtained for staff referral. The concept of abuse is covered in induction and a whistle blowing statement is on display in the staff office. No formal adult protection training has been given to staff since the last inspection and this should be arranged to ensure staff are familiar with current adult protection procedures. Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21,23,24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides warm, comfortable well maintained accommodation EVIDENCE: Lyndale provides pleasant accommodation. The main entrance hall is spacious and there is ample information available regarding the home and the service it provides. Lyndale is based over four floors with accommodation on the ground, first and second floor. A chair lift is in place to access rooms on the mezzanine (no lift access) levels on the first and second floor. The manager assesses the dependency levels of residents before accommodating them on these levels. Different areas of the home were viewed and were found to be very clean, tidy and nicely decorated. Emergency lighting is provided throughout the home and subject to regular tests in house and by the home’s contractor. Records seen were current. Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 18 The home has an ongoing programme of redecoration and refurbishment and day to day maintenance jobs are recorded in the maintenance book. The lounge has comfortable armchairs and coffee tables. This room provides dining space, as there is no separate dining room. Some residents prefer to have their meals in their bedrooms and the staff respect this wish. The bathrooms are fitted with aids to help those less independent and the hot water to the baths is tested and recorded prior to bathing residents. A check of the hot water was undertaken at this time and found to be at a safe temperature. A resident commented on how reassuring it is to know that the staff test the hot water supply. Bedrooms seen had pretty wallpaper and a good standard of furniture and fittings. Personal items from home were present in rooms seen and these included photographs, pictures, pieces of furniture and ornaments. The rooms were ‘homely’ in appearance. A number of radiators have covers in place to minimise the risk of injury to a person and a risk assessment is completed for a bed that may be close to a radiator without a protective cover. It is recommended that the risk assessment be extended for all radiators that do not have a cover. Residents interviewed had a call bell within easy reach and a test of the call bell confirmed that staff answered the bell promptly. The laundry room is situated in the basement and COSHH data is available on products in use. Clothes are returned in individual baskets to the residents and comments from residents included: “My clothes are returned nice and clean” “I get my clothes back quickly”. The grounds are well maintained and accessible to the residents. There is ample car parking space for visitors. Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home employs sufficient staff however recruitment practices are not robust to protect the residents and a number of staff require training in certain areas to ensure they have the skills and knowledge to undertake the work. EVIDENCE: The staffing rota for the week of the inspection was viewed and this evidenced sufficient numbers of staff to care for the residents. Staff interviewed said that staffing numbers were never compromised in anyway and that the manager always arranged cover when needed. Five care staff were on duty the morning of the site visit, two domestic staff, maintenance person, administrator, owner, laundry assistant, registered nurse and manager. At night there is a registered nurse and one care assistant on duty. A member of the care staff comes in at 7am to assist with breakfasts. Residents described the staff as “Pleasant”, “Caring”, “kind”, “Chatty” and “Cheerful”. A resident said, “The staff are good and are here to help” and “The staff are very nice”. Through observation the staff on duty were found to be polite, attentive and caring towards the residents. Good communication was evident between all staff and residents and staff take part in handovers at each shift change to discuss the care of the residents. The home employs male staff and a female resident stated that they were given a choice whether they wished to have a male carer to assist with personal care. Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 20 For the purpose of checking recruitment procedures in the home, the files of four new staff were viewed. Three staff members were recruited via an agency, which deals with recruitment for overseas staff. These staff are qualified nurses who are currently working in this country as care staff. Their files contained a copy of a detailed CV with past employment listed, a photograph, work permit, passport, job contract and copies of references from previous employers in their own country. Their application form is kept with the agency and it would be good practice to obtain a copy for the home’s staff file. The other staff member’s file contained a job application form with details of past employment and two written references. The staff member commenced employment at the home prior to two references being received. Two references must be obtained for staff prior to employment. All four staff commenced employment prior to a POVA (protection of vulnerable adult) check and/or CRB (criminal record bureau) disclosure being obtained. All staff must have a CRB check prior to commencing employment and in exceptional circumstances may commence employment subject to satisfactory POVA first check. A recruitment checklist would be beneficial in each staff file to ensure all the necessary documents are in place prior to employment. Job descriptions are given to staff however there was only evidence of this in one file viewed. Staff are asked to complete a health declaration form. Only one staff member is undertaking an NVQ (National Vocational Qualification) in Care and one staff member has obtained NVQ Level 3. Lyndale employs a high percentage of staff from overseas and they are currently not undertaking NVQs. The home is required to work towards 50 of staff with this qualification. New staff receive an induction and this includes details of care practices. Further information can be obtained from the Skills for Care to enable staff to enhance their knowledge of the induction standards and prepare them for undertaking NVQ courses in care. The home should also look to providing an induction, which is tailored to each position, for example, chef, domestic staff and registered nurse. Staff interviewed stated that they had received an induction when they started and this includes details of the fire exits and what to do in the event of a fire. With regards to training the home has a training matrix and the manager and administrator work together on the training programme. The training matrix evidenced that staff receive training in safe working practice areas however a number of staff require training in the following: First aid to ensure that the people who use the service receive appropriate treatment if they have an accident. Infection control training to ensure correct infection control procedures are adhered to in the home. Only one staff member has attended infection control training. Staff who handle food have received food hygiene training however the administrator stated that a number of night staff also need to attend a course Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 21 to ensure they are aware of the safe handling of foods. As previously stated the chef does provide a booklet on food hygiene for all staff in preparation for the food hygiene course, which is good practice. The home has approached a training company and is waiting for confirmation of training dates. It was agreed that these dates would be forwarded to the Commission. A staff member said, “I have done quite a bit of training and am keen to do more”. All staff attend moving and handling training and further training is booked for this month. Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,32,33,35,36,37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is qualified and creates an open, inclusive management of the home. Residents feel valued and their opinions matter. EVIDENCE: The registered manager, Mrs Sheila Roberts is a registered nurse and has held the position of registered manager for a number of years. Mrs Roberts updates her knwoledge in accordance with her registration and also attends updates with staff for mandatory training. Mrs Roberts has completed NVQ Level 4 in Management and also holds the D32/33 Assessor’s Certificate for NVQ. The owner, Mr Burdett works closely with the manager, administrator and staff. Mr Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 23 Burdett works from the home and residents and staff confirmed that they are able to speak Mrs Roberts and Mr Burdett at any time. Staff described the management of the home as organised and structured. As part of evaluating the care and service, residents and/or relatives are given satisfaction survey forms to complete. These are normally distributed every six months, the last ones being given out in September 2006. Six surveys were read and these did not highlight any major issues. Residents interviewed said they were happy with the management of the home at this time. The home’s policies and procedures are being reviewed and staff are made aware of any changes to the documents. Financial transactions are dealt with by Mr Burdett and incidental expenditures by the administrator. Residents are invoiced each month for services and items, which are not included in the fees. The administrator deals with some personal allowances and it is recommend that staff signatures be evidenced in the residents’ incidental records when recording transactions. Four records were seen for this purpose. Supervision is arranged for staff and a staff file viewed evidenced recent supervision meetings. Resident and staff meetings are held; a resident meeting has been booked for March 2007. A resident said they were looking forward to it. With regard to promoting the health and safety of residents the requirement for staff training has been stated under Standard 30 of this report. The pre inspection questionnaire provided evidence of the servicing of equipment and maintenance contracts. These were in date and a spot check was also undertaken of the gas, electric, portable appliance testing and manual handling equipment certificates. Staff receive fire awareness training has part of their induction and every six months. The fire log book also evidenced that the fire alarms are tested weekly and the emergency lighting monthly. Servicing of the fire prevention equipment was taking place during the site visit. The fire risk assessment of the home was updated in October 2006 in line with new guidance from the fire department. Any accident affecting the well being of the resident is recorded. A separate record is also placed in the resident’s care file for monitoring purposes. Sufficient detail had been recorded in an accident report viewed. Lyndale DS0000017248.V327847.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 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 Supervision has been provided for some care staff and needs to be ongoing. CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 Score X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 Lyndale 3 3 3 X 3 3 3 4 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 Score 3 3 3 X 3 3 Version 5.2 Page 25 DS0000017248.V327847.R01.S.doc 17 18 x 3 37 38 X 3 Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The registered person must make arrangements for the safe administration of medicines received in the care home (The requirement refers to the morning medicine round). The registered person must ensure two written references are received prior to a staff member commencing employment. The registered person must ensure new staff do not commence employment prior to a CRB disclosure being obtained. Staff may start work pending a CRB if a POVA check has been received. The registered person must make suitable arrangements for the training in first aid, food hygiene and infection control. Timescale for action 08/03/07 2. OP29 19 Schedule 2 19 Schedule 2 08/03/07 3. OP29 08/03/07 4. OP30 18(1) 13(4) 08/04/07 Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 27 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. Refer to Standard OP8 OP8 Good Practice Recommendations The home should encourage senior care staff to record the care they give. The home should ensure all health care needs are recorded in good detail and introduce wound care charts for recording details of the wound, treatment and progress of the affected site. Residents should be weighed as part of their nutritional assessment. It is strongly recommended that the home look to undertake the morning medicine round after 8am after consultation with residents. Advice should be sought from the home’s pharmacist and residents’ GP regarding time of administering medicines. The home should access medicine awareness training for staff responsible for medicine administration. The home should look to provide formal abuse awareness training for staff and obtain a copy of Sefton’ s Protection of Vulnerable Adult Procedures. The home should complete a risk assessment for those radiators that do not have protective covers in place. The home should continue with NVQ for care staff to provide a minimum ratio of 50 with a qualification in care. The home should obtain a copy of the staff application form held by the agency. The home should contact Skills for Care regarding the standards of induction and tailor the induction for each position of work The home should sign the incidental records when dealing with residents monies 3. OP9 4. 5. 6. 7. 7. 8. OP16 OP25 OP28 OP29 OP30 OP35 Lyndale DS0000017248.V327847.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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. 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