Inspection on 05/07/07 for Lynde House

This inspection was carried out on 5th July 2007.

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

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

Other inspections for this house

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Lynde House Meadowbank 28 Cambridge Park Twickenham Middlesex TW1 2JB Lead Inspector Sandy Patrick Unannounced Inspection 05 July 2007 09:00 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 Lynde House DS0000069406.V336418.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. Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lynde House Address Meadowbank 28 Cambridge Park Twickenham Middlesex TW1 2JB 020 8892 4772 020 8744 3997 lynde@barchester.com 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) Barchester Healthcare Homes Ltd Mrs Lynda Ann Garner Care Home 72 Category(ies) of Old age, not falling within any other category registration, with number (72), Physical disability over 65 years of age of places (72) Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can admit service users from the age of 60 upwards. Date of last inspection 28th February 2007 Brief Description of the Service: Lynde House is a nursing home for 72 older people. The home is purpose built and everyone living there has a single room with en suite facilities. There are large communal areas and an attractive garden. The home is in East Twickenham, close to local shops, transport links and not far from Richmond town centre and the river Thames. Nurses and care staff work at the home throughout the day and night. Lynde House have created a written guide which includes information about the home and the Aims and Objectives. The weekly fees are between £980 - £1,080. Fees include all services except chiropody, hairdressing and newspapers. Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection included an unannounced visit to the home on 5th July 2007 by two Regulation Inspectors. We met with people who live there, visitors, staff and the Manager. We also looked at records and the environment. And we looked at how people were cared for. We asked people living at the home, their visitors, staff and other professionals to tell us about their experiences using short questionnaires. 16 people who live at the home, 5 of their visitors and 9 members of staff returned our questionnaires. We asked the Manager to complete a quality self assessment of the service. We did our last full inspection in July 2006, but we also visited the home in February 2007 to see how they were getting on at doing the things we had asked them to do. We used all these sources of evidence to help us to make judgements about the service. Most people told us that they liked living at the home. They said that the staff were generally pleasant. Although some people said they were often rushed and did not always listen to them. Most people liked the organised activities but some would like different things to do as well. People had mixed feelings about the food. Some people felt that they were not always getting value for money with the service they received and the food. Visitors told us that they were made welcome and that staff were generally polite and helpful. Some of the things people told us were: ‘I like living here.’ ‘A first class, well managed establishment.’ ‘On the whole I am satisfied, but the care givers need more training and sensitivity to individual needs.’ ‘The staff are pleasant and the Manager is always available when you want to see her.’ ‘Cheerful staff and good food.’ ‘Lynde House is one of the most caring, welcoming delightful place.’ ‘I enjoy working with this company and especially this nursing home.’ Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? There have been some improvements to the way in which people’s care needs are recorded. There have been improvements for people interested in moving to the home and for people when they first move in. Each person has been allocated a named worker who will help make sure they get the care and support they need. There have been improvements to the environment and to the garden. There have been some new activities and regular residents’ meetings. There have been improvements for people at mealtimes. Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 7 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. Lynde House DS0000069406.V336418.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 Lynde House DS0000069406.V336418.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): 1, 3 & 5 Standard 6 is not applicable. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who are interested in moving to the home are given a good range of information and are able to visit to help them make their decision. People moving to the home are assured that their needs have been assessed and that the home is able to meet these. EVIDENCE: There is a service guide for the home which gives a good range of information. Copies of this are given to people who are interested in moving to Lynde House. Most people told us that they had enough information to help them make a decision about moving to the home. One person said that they would like the information on fees to be clearer. Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 10 The Manager told us that the organisation had updated and improved the information about the home. She showed us the new information and told us that everyone would be receiving a copy of this. When people are interested in the home they are sent a welcome pack, which includes the service guide, information about the local area, terms and conditions, important contacts and a letter clarifying the charges. People are also asked to complete a feedback form about their initial experiences so that the Manager can look at what people find useful and if there is anything else that they want. People interested in moving to the home are able to visit with their families and have a meal. Senior members of staff meet with potential residents, their families and other professionals to complete an assessment which outlines their needs. We looked at some people’s records and saw completed assessments in these. When someone moves to the home they are allocated a named carer and nurse who makes sure their care and health needs are being met. The Activities Officer, Chef and Physiotherapist meet them to discuss their needs in each area. There are check lists to record the discussions that these staff members have and to make sure individual needs have been discussed and recorded. One person living at the home has said that they would like to help show new people around. The Manager said that they are going to be allocated this role. Lynde House DS0000069406.V336418.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): 7, 8, 9, 10 & 11 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People living at the home have their needs recorded, but the records of these are not clear and need to be improved. Some people are involved in planning their care but others need to be more involved. Some people feel that their health and personal care needs could be better met. People are confident that their medication is looked after properly. EVIDENCE: Everybody has his or her needs recorded in a care plan. We looked at some of these. Some care plans were well laid out and had detailed information. Other care plans needed to be improved. We found that some of the care plans were mixed up and difficult to understand. Some care plans had old information and more recent information which contradicted it. Some of the language and terms used by staff in care plans and daily notes were found to be negative. These included, ‘toileting’, ‘grooming’, ‘(the resident) complained…’, ‘their weight is a problem’ and ‘cognitively alert’. There was not very much Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 12 information on people’s social needs. Everyone had care plans about the same things, even if they didn’t have any needs in this area. Some people had not been involved in making their own care plans and the way they were written meant that they would have found them difficult to understand. Some care plans did not always use a person’s preferred name. One care plan referred to ‘an elderly lady’ not the person’s name. The care plans and daily entries indicated that staff focused on the tasks they had assisted with not on how someone was feeling, whether they were happy or what their wishes were. One person told us that they found their care plan too long and complicated and that because of this the staff did not always know their specific needs. New residents told us that there was not a formal system for reviewing their care and that they were not involved in this. Where people faced risks or restrictions were in place these had sometimes been assessed. However, some restrictions had been made which were not assessed. For example some people had beds equipped with detachable rails which prevent them from getting out of bed on their own. The use of these must be fully assessed and the person, or their representative, must be asked for their consent. This must be recorded. Personal information about one person was displayed where others could see it, however this was agreed by their family. Some people had equipment to help them get around. This had been labelled with their names at their request. The labels were large and did not look personalised. The staff should think about how equipment is labelled and try to do this in an attractive way. One person told us that the staff focused on tasks and did not always consider their individual needs. They said that the staff attended to tasks but did not always ask people how they were or if they needed anything. Some people felt that they were not supported in the way they would like. Some of the things people told us were: ‘Some of the care is hurried.’ ‘I am given two showers a week and would like to have them daily.’ ‘Some of the night staff do not give the attention they should and have a poor attitude.’ ‘Occasionally my relative is not shaved.’ Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 13 Everyone is registered with local GPs and they visit the home to hold a regular surgery. A community nurse from the Primary Care Trust has started working closely with the staff. She visits the home regularly and meets with residents and staff to make sure people are receiving the nursing care and medical support they need. The Manager said that this support is working well and benefiting people. Some of the things people said about the medical support they received were: ‘I do not always get the results of my medical tests.’ ‘I often have to wait a long time to find out the results of tests done by the doctor.’ ‘It is difficult to see the doctor.’ ‘I am not always added to the doctor’s visits.’ People told us that they could see the doctor and other health professionals but not always when they needed to. Some people felt that the staff needed more training and information to understand their health care conditions. For example one person said that the staff did not realise when they had a particular illness and did not alert the health professionals as quickly as they would like it to be. Another person said that the staff did not understand the needs of people who had their particular health conditions. We found that some people had health conditions and needs associated with these which the staff were not always clear about. For example one person had dementia and information written about them was not always clear. The staff had not had training or the information they need to support these people. Some people have wounds and specific injuries. The information that staff kept on these varied. Some information was very good and showed clearly how the wounds needed to be cared for. However, the information written about other people was neither clear nor detailed. Some records indicated that wounds had not been regularly assessed. Some people’s records indicated that their condition had worsened since they had been at the home. Some people had the care of more than one wound recorded in the same plan. There was insufficient information on some wounds. Some records indicated that relevant health professionals had not been contacted to help care for wounds as soon as they should have been. There were insufficient photographs of some wounds. Some records were not dated. There is an appropriate medication procedure. Staff administering medication are trained. We looked at how medication was stored, recorded and administered. All medicines were stored securely and, with the exception of one medicine, appropriately. One medicine was not refrigerated when it should have been. Records were accurate. People are able to look after and administer their own medication if they wish to. There are good systems for Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 14 checking medication records and storage. Most people told us that they were happy with the support they had to take the medicines they needed. One person said, ‘I am not always given my tablets on time’. However it was aknowledged that due to the number of residents receiving medications some will receive these at a slighter later time in the round. Some of the staff are attending specialist training to help them support people who are coming to the end of their lives. Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 15 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): 12, 13, 14 & 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People are able to participate in a range of organised activities however people need more support to pursue individual interests. Visitors feel confident that they are welcomed and able to continue to care for relatives if they wish. There are good systems to support people to speak up and give their views about the service but sometime they are not always given choices about their individual care and support. EVIDENCE: There are two allocated Activities Officers. They have organised a range of planned activities and outings. These are well advertised. Some regular activities, such as morning coffee and reading the newspapers as a group are popular. There are also special events organised with entertainers. There was due to be a garden party the week after our visit. Birthday parties are organised for those who wish and a private area is allocated for people to celebrate with families and friends. Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 16 Some local places of worship visit the home and hold services for people who wish to participate. A physiotherapist holds weekly exercise classes and these are a popular activity. A residents’ choir has been formed. popular activity. They meet weekly and this is a very Most people told us that they enjoyed or usually enjoyed the planned activities at the home. Some people said that they could not join in with activities because of a disability. People told us that sometimes they wanted more support to pursue their individual interests and hobbies. We looked at the records the home had on these and we thought that they needed to be improved. Information about people’s lives before they moved to the home also needed to be improved. Where individual interests and hobbies were recorded we could not find any evidence to say that people were supported to pursue these. However at the time of inspection it was noted that the home was replacing existing documentations to new ones. Some people said that they were left alone and that the staff did not come and ask them if they were alright or needed anything. One person said that they needed help to write letters, remember relative’s birthdays with cards and to make to telephone calls, but they were never helped with these things. Some of the things people said about activities were: ‘I have enjoyed some of the activities. Unfortunately they are not always continued especially the outings and walks to the park.’ ‘The activities team organise good DVDs and films on TV.’ Some people told us that they would like the carers to spend more time just chatting to them. Since the last inspection the Manager has introduced a system where everybody has a named nurse and carer allocated to coordinate their support and care. One person told us that this had improved the care they had received to some extent, but that people did not always know about their individual needs. Most people told us that the staff listened to them and acted upon what they said. Some people said that the staff sometimes seemed to ‘forget’ what they had asked them and never came back with an answer or requested item. Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 17 Some people told us that carers were not always polite. One person said that staff had asked them, ‘what do you want now?’ We saw that some staff were very polite and helpful to residents. One member of staff was involving someone in reviewing their care plan. However, we also saw examples of some staff assisting people without speaking to them. One person was assisted to stand up by two members of staff. The members of staff spoke to each other and shared a private joke. They did not offer the person reassurance. We saw another member of staff asking someone personal questions in front of others while filling in a form. They did not tell the person why they were asking these questions and walked away again without explanation. There is good information for people living at the home including activity notice boards and menus on display. There are regular meetings for everybody. One of these was held on the day of our visit and we were invited to attend. Everyone was given a chance to contribute. The Manager told people about different services, changes and plans. People were able to make comments and ask questions. The Manager listened to what people had to say and agreed to take action to address any concerns that they had. People can choose to eat in the home’s dining rooms or their own rooms. There are two dining rooms, however people do not always have a choice about which dining room they can eat in. People who need assistance or support at mealtimes have to use a separate dining room. The staff have made efforts to make the dining experience the same in this room, offering people choices and playing music. The chef talks to people in both dining rooms about their enjoyment of each meal and there have been improvements for diners in this room. Staff who support people sit with them and offer them choices about their meal. Residents were seen to sit at the table on the day of inspection based on need and disability however they can choose to sit anywhere if they want to. One person has been asked by the Manager if they would be willing to move to a different bedroom and they have said that they do not wish to. The right of this individual to stay in the room has been respected. The organisation should consider how they can involve the people who live at the home with recruiting staff and the Inspecotr was told that there is one resident who shows new staff around the building. Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 18 People can receive visitors at any time. Visitors are able to join relatives for meals and have allocated private space for parties or gatherings. They can continue to care for their relative if they wish. Most visitors told us that they were made welcome. We found that all staff were very polite to visitors. They said that they were kept informed of any emergency. However, some relatives said that they would like regular, planned meetings so that they could discuss how their relative was being cared for. The chef meets with people when they move to the home to speak about their dietary requirements. Specialist diets are catered for and people are able to make choices about what they eat. The chef uses seasonal food and creates a varied menu. People were given the opportunity to comment on their meals at the residents’ meeting. Most people said that they were happy with this. However on the day of inspection the Inspector spoke to some people who had mixed feelings about the food served, some comments were good while the others were less favourable and need to be addressed and these are listed below:‘I enjoy the varied lunches with plenty of vegetables. The evening supper is less good and is sometimes unappetising in appearance.’ ‘I sometimes eat my meals in my room and they are cold by the time I get them.’ ‘I would like more fresh fruit and vegetables.’ ‘I expect better quality food for the prices I pay.’ ‘Some of the food defies description and is not very good.’ ‘Compared to the last home I was in the food is not as good or nutritious. But it is well presented.’ ‘Considering that we are always being told we live in a 5 star home I, and quite a few other residents, think the food is appalling. It is poor quality, badly presented and mostly tasteless.’ ‘I love my food but never look forward to meals here.’ Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 19 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): 16, 17 & 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There are appropriate procedures regarding complaints and protection. EVIDENCE: There is an appropriate complaints procedure. Records of all complaints and concerns are kept. We looked at these. They showed us that action had been taken to investigate concerns. People told us that they knew who to speak to if they were unhappy and how to make a formal complaint. One person told us that when they made a complaint it was dealt with appropriately. There is a copy of the local authority protection of vulnerable adults procedure and staff are aware of this. Staff have had training in recognising and reporting abuse. The organisation has its own procedures on abuse and whistle blowing. There is information on local advocacy services available for residents. The Manager asked people if they would like an advocacy group to attend their meetings and to support them as a group. People said that they would like this and it is being arranged. Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 20 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): 19 & 26 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. People live in a safe and well maintained environment. EVIDENCE: The home is purpose built and everyone has their own room with en suite facilities. There are some adjourning rooms for couples or those who wish to share. Some of the rooms have direct access to the garden. There are a number of nice communal lounges and two dining rooms. These are nicely laid out with furniture arranged in a homely fashion. Communal areas, corridors and bathrooms are appropriately equipped and furnished. There are personal touches such as pictures, fresh flowers and ornaments throughout. These are updated regularly. People told us that they liked the environment and that it was well maintained. They said that they felt relaxed and comfortable. Everyone is able to furnish and personalise their own rooms. Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 21 There have been improvements to the building over the last year and further improvements are planned, these include changes to communal areas, redecoration of bedrooms, refurbishment of bathrooms and new flooring. Lounges have a variety of music equipment, TVs, books, games and magazines for people to use as they choose. There is a large and attractive garden which leads down to the river Thames. This has accessible, flat areas. The garden was being improved when we visited and new raised beds, flower arrangements, seating areas and a fountain were being built. People told us that the home was kept clean and tidy and that they liked the environment. There is a maintenance worker and a team of domestic and housekeeping staff. There is detailed information to make sure they look after the environment and checklists to make sure things have been attended to. Some people told us that they were concerned that laundry went missing or that they had been given other people’s clothes. Some people said that they were not happy with the way their beds were made. Some of their comments included, ‘I am not happy with the bedmaking. Some carers do it wrong and I have to remake my bed myself which is very tiring.’ And ‘I do not like the polyester sheets and would like cotton ones.’ These issues were also discussed at the residents’ meeting we attended. The Manager listened to what people said and started to take action to rectify their concerns. Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 22 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): 27, 28, 29 & 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People living at the home are protected by thorough staff recruitment procedures. Staff are well trained and supported. EVIDENCE: Most people told us that the staff were kind and caring. They said that they were generally available but that sometimes they had to wait a longer time than they would expect to get attention. Some people felt that there were staff shortages. Other people said that the staff focused on completing care tasks and did not spend time checking that people were happy, chatting to them or finding out about individual needs. Some people felt that staff rushed the jobs they were doing. People told us: ‘Staff are gracious and courteous.’ ‘Sometimes when I have asked a nurse for assistance I have had to wait sometime. But the carers respond quickly. The staff generally listen to me and understand.’ ‘Sometimes we have to wait a while for staff.’ ‘I feel there is not sufficient staff at weekends.’ Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 23 A new senior member of staff has been employed to manage one area of the home. There are two senior nurses who work alongside the Manager and Deputy Manager to organise the day to day management of the home and offer support and guidance to staff. The staff we spoke to told us that they had been recruited through a formal interview. They said that checks, including criminal record checks, had been made before they started work. They told us that they had participated in induction training and had attended other training courses since. Some staff were dissatisfied with certain company policies and procedures, such as pay and sickness. One person said: ‘We had an induction and have regular different training.’ The staff told us about different training courses they had attended and how they had used these to help them in their work. Some staff told us that they were undertaking NVQ Awards. One member of senior staff is allocated to support others with different training needs. There is a record of all staff training. This shows that staff have had relevant training in key areas and indicates where people need additional training. Training is well advertised to staff. The organisation is supporting care, domestic, catering, administrative and management staff to undertake different relevant NVQ awards. A member of staff is a qualified manual handling trainer and they offer training, support and guidance to all staff. Some people felt that the staff needed more training to understand certain health conditions. We felt the needed more training to understand about dementia. There are appropriate procedures for recruiting staff and checks are made on them before they are employed. We looked at the records for some staff. These contained evidence of thorough recruitment. Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 24 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): 31, 32, 33, 35, 36, 37 & 38 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. People benefit from a well managed service where they are listened to and the Manager is committed to making improvements. EVIDENCE: A new organisation took over the ownership of Lynde House in 2006. They employed a new Manager. The Manager is experienced and is suitably qualified. Since she has worked at the home she has introduced some positive changes. She has consistently demonstrated a commitment to improving the service. She showed a good knowledge of the people living at the home, the staff and about how changes need to be made. She has shown us that she listens to the CSCI and wants to do the things which we ask. Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 25 Residents, visitors and staff all praised the Manager for her approach and said that she was open and supportive. The staff told us that the Manager was very good. They said that she was approachable and listened to them. They felt that the service was well run and that they were well supported. Some of the things that they said were: ‘I appreciate the good management.’ ‘At the moment we have a good manager who you can see and ask for assistance in all areas. She is very supportive.’ ‘The home has good management.’ The Manager said that the organisation was very supportive and that they provided the funds, training, equipment and support that were needed. The Manager meets with senior staff every month. They develop an action plan which looks at the improvements needed in different areas. They also meet each morning to discuss any specific needs for the day. There are regular staff meetings and these are recorded. All staff have regular individual supervision meetings with their manager. People who live at the home manage their own finances or make their own arrangements for a representative to manage these. Any additional costs incurred at the home are reimbursed via invoice. The organisation sends a senior manager to visit the home monthly and carry out a quality audit. They write a report of their findings and give us a copy of this. There are systems for asking people living at the home and their visitors what they think. These include regular residents’ meetings, a suggestion box and questionnaires for everyone, including people who have recently moved to the home. Recent questionnaires returned to the home indicated that people were happy with the care and services they received. The Manager had recorded an action plan to address areas of concern. The records kept by the Manager to help with the smooth running of the home and monitoring quality are very well organised. They are accurate and up to date and information is clear and easily accessible. There are regular checks on health and safety and records are accurate and up to date. These show that any problems which have been identified are rectified quickly. Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X N/A 3 4 3 Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12 15 Requirement Timescale for action The Registered Person must 31/08/07 make sure people who live at the home are involved in planning their own care based on their needs and wishes. Care plans must be recorded in a clear way which the people who they are about can understand. There must be evidence that the person or their representative has been involved in the development and review of the care plan. People must be given a copy of their plan. Staff must use the person’s preferred name at all times. Previous requirement 30/06/07 2. OP7 15 The Registered Person must 31/08/07 make sure care plans are appropriately detailed and clear. DS0000069406.V336418.R01.S.doc Version 5.2 Page 28 Lynde House Care plans should only written when there is recognised need. be a Old information should be removed from the care plan and stored elsewhere so that only current care needs are clear. 3. OP7 12 13 15 The Registered Person must 31/07/07 make sure all risks and restrictions are appropriately assessed involving the person or their representatives. Their wishes and views should be paramount in making a decision and must be recorded. The Registered Person must 30/09/07 make sure people’s individual social needs and wishes are recorded. And that there is a plan of care to support people to meet these. The Registered Person must 31/07/07 make sure that wounds and the treatment of these are documented clearly, including evidence of whether the treatment is effective, regular assessments and contact with relevant health professionals. Previous requirement 30/06/07 6. OP10 OP14 4 12 The Registered Person must 31/07/07 make sure people are treated with respect and dignity, that their privacy is maintained and that their care is given in a way which they have chosen. The staff must make sure they Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 29 4. OP7 OP12 12 13 15 16 5. OP8 17 focus on the needs and wishes of the person and not the task they are performing. Previous requirements 30/11/06 & 30/06/07 7. OP8 OP30 12 18 The Registered Person must 30/09/07 make sure the staff have the training, information, knowledge and skills to support people with their different health care conditions. The Registered Person must 31/07/07 make sure personal information about anyone is not put on public display. 8. OP10 12 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 OP8 Good Practice Recommendations The staff should make sure people are able to see the GP when they wish to. The staff should make sure people are given the results of medical tests as soon as possible and that they are proactive in asking health professionals to provide the results in a timely fashion. Medication should temperature. always be stored at the correct 2. OP8 3. OP9 Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 30 4. OP9 The staff should try to administer medication at the correct time and must give reassurance and explanation to the resident if for any reason this is not possible. Personal equipment should be labelled in an unobtrusive manner and in the style of the resident’s choice. The staff should make sure they spend time checking people are alright and happy. They should recognise the importance of social interaction and conversation and should make sure they spend time meeting these needs of the people living at the home. People must be supported to join in activities regardless of their disability and should not be made to feel excluded. The staff should make sure people have the support they need to write letters or cards to help them stay in touch and celebrate family and friends’ birthdays and special occasions. People should have enough opportunities to go on outings and be supported to leave the home regularly if they wish. The Manager should offer regular, planned meetings between the named nurse, keyworker, the resident and relatives to discuss care needs. The Manager should consider how the concerns expressed to us about food and meals can be addressed. The staff should make sure clothes do not go missing in the laundry and that everyone is given their own clothing. The staff should make sure they make beds the way the resident would like their bed made. The Manager should make sure the allocation of staff allows for people to get the care they need. DS0000069406.V336418.R01.S.doc Version 5.2 Page 31 5. OP10 6. OP10 OP12 7. OP12 8. OP13 9. OP12 10. OP13 11. OP15 12. OP26 13. OP26 14. OP27 Lynde House Lynde House DS0000069406.V336418.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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