Inspection on 24/05/05 for Lynden

This inspection was carried out on 24th May 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lynden 10/07/08

Lynden 15/06/06

Lynden 11/02/06

Lynden 04/11/04

Lynden 03/06/04

Lynden 23/02/04

Lynden 09/10/03

Lynden 28/10/02

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

CARE HOME ADULTS 18-65 Lynden 18 Thornton Road Morecambe Lancashire LA4 5PE Lead Inspector Jennifer Dunkeld Unannounced 24 May 2005 10:00 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 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 Stationary 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. Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Lynden Address 18 Thornton Road, Morecambe, Lancashire, LA4 5PE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01524 420762 Mrs Kathryn Lesley Regan Mr Robert John Murray Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th November 2004 Brief Description of the Service: The Lynden has been registered for a number of years to care for up to 11 adults with a learning disability The home is a large terraced property in Morecambe, situated close to the promenade. There are two lounges/dining rooms for the use of the people who live at The Lynden There are 9 single bedrooms and 1 flat which has a double bedroom. A married couple currently occupy the flat. There is a patio to the rear of the home where the residents may sit out, weather permitting. Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first of two to be carried out this year. The inspection was unannounced, in that neither the people who provide the service nor the residents and staff were aware that it was to take place on the 24th May 2005. The inspection lasted 4.5 hours. The inspection was carried out to ensure the home complied with the National Minimum Standards for Adults. A large part of this inspection was spent talking with the residents and observing the staff at work. All the residents spoken with said they liked living at The Lynden . One man said ‘They are so good to me and I like the staff’. Another said ‘I have lived here a long time and I like it here because the staff and Kath (service Provider) are nice to us’ When asked ‘what would you do if you were unhappy about something?’ the general response was ‘tell the Kath or the staff and they would sort it out’ There were 2 Senior Care Staff and two other care staff on duty at the time of the visit. The service provider was also in the home but was in a meeting. The care staff also do the cooking. The inspector gained the impression that the quality of life for the residents was as they choose it to be and therefore met their needs. The staff spoke with the residents in a respectful manner and offered choices to people. The Inspector spoke individually with the staff on duty who were positive about the home and the care on offer. They stated that training is offered to them to improve their knowledge. The 2 senior carers on duty had a positive approach to their work and related well with the residents. The home’s records that are required to be maintained were viewed by the inspector, who was able to confirm these were maintained in a manner to protect the finances of the residents. The menus were studied and whilst the residents were happy with the meals provided, some additional information and advice is being offered to the management team. Mr Simon Hill a Pharmacist Inspector accompanied Mrs Jenny Dunkeld on this inspection. He inspected the homes medication handling systems and has written a separate letter to the home outlining the outcomes. Whilst some advice was given on how to improve some aspects of these systems the homes medication procedures were generally good. Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 7 contacting your local CSCI office. Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 9 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 standard(s) We looked at outcomes for Standards 2 and 5. There is a good system for assessing the needs and abilities of all prospective residents. This is when the prospective resident and their relative/representative will be asked a number of questions about the needs of the individual to ensure their choices, needs, preferences and aspirations can be met at the home. Each person at The Lynden has an agreed contract/ terms and conditions of residence. EVIDENCE: The written assessments of 3 residents were examined. One of them had been at the home for over a year and she was content in the care she receives. She said she does not like going out much but prefers to stay in and occupy herself. She said she liked living at The Lynden and that the food was good. Another resident said he liked going out on his own or with another resident that he has made friends with. The written records reflected that all aspects of each individuals care is assessed. These included mobility, activities, hobbies, food likes, assistance Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 10 needed to bathe and other areas that will ensure the person receives the care and support they need. From the assessments each person has an individual plan drawn up reflecting how their needs and wishes will be met, the inspector viewed the plans of care for 3 residents. Their needs and aspirations are recorded in a booklet “Me and My” These records reflected who are important people in the life of the individual and the dates that are important to them. There is also a section headed “What makes me happy” One mans record stated; ‘Going on holiday’ ‘Seeing my family’ ‘Having a laugh with the staff’ ‘Going to Blackpool illuminations’ ‘Using my bus pass as I get cheap fares’ ‘Day trips’ On the day of this inspection he was taking himself to the Isle of Man for 2 days. He showed the inspector photos of day trips he’d been on with his friend. The written contracts/ terms and conditions of residence that were viewed by the inspector were written in plain English and were easy to follow, reflecting the services the person would receive. Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 11 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 standard(s) 6 & 7 The people who live at The Lynden are aware there is a written plan of care about them and contribute to the information in their plan of care. They are encouraged and enabled to make important decisions about their life meaning that individual needs and choices are met. EVIDENCE: The people who live at The Lynden told the inspector that they make the decisions about their life, including when to get up, what to wear, what they want to do, where to go on holiday and who they want to assist them. The inspector looked at three plans of care, which reflected the needs of the individuals and how the support is to be provided. The inspector observed the staff asking the residents for choices during this visit, such as ‘What would you like for lunch?’ ‘Would you like me to help you with that?’ Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 12 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 standard(s) 12, 13 and 17. There are real endeavours being made to encourage people to have an active meaningful lifestyle according to individual interests, abilities and age. The atmosphere is lively and people speak freely about their lifestyle. The management and staff support people to maintain their place in the community and residents benefit from this. EVIDENCE: At the time of this visit here are some of the activities that were happening; one lady was busy doing a difficult jigsaw. One man was getting himself ready for his trip to the Isle of Man Another man was going out for a walk on the promenade. One woman was out visiting her friend. 2 men told the inspector of their day trip to Edinburgh that they had been on the previous week. Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 13 There were various samples of ‘Art and Craft’ around the home that had been made by the residents under the guidance of the woman who is employed once every 2 weeks to carry out craft work etc. In addition to the above the inspector viewed the homes photo album of people taking part in various activities and outings. Each persons plan of care includes their hobbies and interests. The residents also told the inspector of their planned trip to ‘Emmerdale Farm’ And of the weeks holiday they are having in Blackpool in the summer. The hotel brochure was shown to the inspector and this was of a high standard. The residents said that some people go to church, but some of them do not wish to go. Each persons care file, which contains all the relevant information about them such as the plan of care, their contract/ terms and conditions of residency, it also incorporates a list of their dietary needs, likes and dislikes. The inspector observed a healthy/appetising meal being served. A choice was of meal was being offered. The inspector viewed the record of meals served over the previous 3 weeks and whilst the lunch and teatime were meals were recorded, there was no detail of the content of the breakfast and suppers that were served. The Senior carer on duty was advised on the need to record all the meals offered as evidence of the balanced and nutritious diet that is on offer. The inspector will send the home a copy of the general advice about meals in care homes, as supplied by the Community Dietician. People when questioned spoke highly of the meals they receive with comments such as ‘ooh the food is good’ and ‘We get plenty to eat’ ‘The staff ask us what we would like to eat’. Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 14 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 standard(s) 18 & 20 The people who live at The Lynden are supported to ensure their physical and emotional health needs met. The staff provide personal support to people in a way that suits the residents needs and preferences meaning that, residents remain satisfied and contented. Medication is administered as prescribed however staff involved in the administration of medication must be trained to do so. EVIDENCE: The pharmacist inspector looked at all the homes records and policies in relation to medication and spoke with the senior carer on duty. A separate report has been sent to the home in relation to medication it’s storage, administration and recording of the same. The report is available upon request to the Commission For Social Care Inspection. The residents individual plans of care have a detailed record of all professional visits, such as Doctor, Dentist, Chiropodist, Psychiatrist and the District Nurse where appropriate. The inspector viewed three of the residents records which reflected that people received the health care treatment as and when they needed it The people who live at The Lynden told the inspector of the health supports they receive and said that a member of staff goes with them for appointments where this is necessary. Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 15 One man said that the District nurse calls to dress his pressure sore that he was admitted from hospital with. Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 This home has good evidence to indicate that residents are able to talk freely about any concerns they may have and that the staff at the home act on all expressions and views made by the residents meaning that residents are confident that their views are important in the home . EVIDENCE: The residents told the inspector that if they were unhappy about something they’d tell Rhuanda (Senior Carer) and they were confident that she would see that it was put right. The home has a clear complaints procedure that tells people how to make a complaint and some of the residents were aware of it’s content. However some of the residents do not have the ability to follow a procedure and staff said that they look for any change in mood that may be related to someone not being happy about something. They would try to find out what was wrong and put it right. All the residents and/or their family receive a copy of the home’s complaints procedure. The management team hold meetings with the residents to discuss various topics. The inspector viewed the record of the last 2 meeting. These reflected that the residents are asked for their views on the menus and on holidays/trips out. They also discuss the décor of the home. From discussion with the residents and from viewing the records of meetings it is evident that people have their views acted upon. Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 17 The records of Staff Training show that training is given to staff in relation to the homes ‘Complaints Procedure’ There is a relaxed and friendly atmosphere at The Lynden, which undoubtedly stems from the security that people gain from living in an environment where their needs and wishes are listened to. Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 The home is clean and hygienic and, in the main, comfortable and safe. This means that people living at the home do so in an environment that is homely, however there are areas of the home that require improvement EVIDENCE: The inspector viewed the whole of the home and whilst it was clean and hygienic in all areas, there were some areas that required some attention. Some rooms are beginning to look as though they are in need of decorating, a process, which often takes place while the residents are away on holiday to ensure least disruption. The following comments should be addressed; One mans chest of drawers is in need of repair. Some of the lounge chairs are looking tired and would benefit from being replaced. Bedroom 8 needs a new carpet. Bedroom 9 needs a new carpet and decorating. The lounge curtains have been removed and vertical blinds are in situ. Whilst the residents are happy with this arrangement the lack of curtains detracts Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 19 from the homely atmosphere and looks more like an office than a home. The residents need to be shown what alternatives there are to heavy curtains which ‘take the light of the room’’ according to one resident , in order that they can make an informed decision. The records of some of the residents were examined and they clearly show that risk assessments are carried out to ensure that everyone is cared for safely. Risk assessments look at areas of the home where residents may be at risk, such as in the bathroom. Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 Generally a good compliment of trained staff are employed by the home and residents needs are met to a satisfactory standard. However recruitment practices in terms of references and checks are unsatisfactory. EVIDENCE: The staffing rotas were checked and they showed that an adequate number of staff are on duty during each shift. The staff said there are enough of them to provide a good quality of care to the residents. Staff Training files were also viewed and they included evidence of; A thorough staff induction programme using the Learning Disabilities Award Framework. National Vocational Qualification in Care at level 2 achieved by 3 staff and 2 staff are currently attending this course. National Vocational Qualification in Care at level 3 achieved by 1 member of staff. This reflects that the recommendation for 50 of care staff to gain this qualification is almost met. Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 21 First Aid , Moving and Handling and Food Hygiene courses are also completed by staff. One resident has a Dementia and staff have been attending a ‘Dementia Awareness course, to ensure his needs are appropriately met. The inspector viewed the ‘staff records’ for 3 staff. That is the information surrounding their recruitment, application form and references in addition to Criminal Records Bureau clearances. The inspector observed that information had been collated in a thorough manner but in one case had been acted upon. The inspector has written a separate letter to the home in relation to this matter. The homes management team must ensure their robust recruitment procedure is followed; ensuring verbal references are followed up in writing and acted upon. Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 The homes management team is experienced and qualified. The home is well managed. EVIDENCE: The staff stated that the residents’ are encouraged to manage their own finances whenever this is possible. However some people due to their disability are unable to understand their finances. The management keep individual, thorough records of all transactions. The money is securely stored, two staff witness each entry into the record and check the balance is correct. The health of the people who live at The Lynden is well promoted, each residents record shows their individual medical needs and how these are addressed. All medical appointments are recorded. Residents are supported to go to the Doctors as necessary. Medication is given at the correct times and at the right doses. The record of medication was evidence of this. Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 23 The homes manager has achieved the ‘Registered Managers Award’ and has a large number of years experience in the care of people with a learning disability. Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 4 x x 3 Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x x x 3 Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Lynden Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 25 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement The manager must ensure an accurate record is kept of all medicines received into the home. The manager must ensure all medicines are accurately recorded when disposed of and when leaving the home. The manager must ensure that verbal staff references are followed up in writing and act according to the information received. Timescale for action 30.6.2005 2. YA20 13(2) 30.6.2005 3. 34 19(1)(a) 2.6.2005 4. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA20 YA20 YA20 Good Practice Recommendations A list authorised signatories along with sample initials and a photograph of the resident should be kept with the MAR. A suitable design controlled drugs register should be obtained Handwritten MAR should be an exact copy of the dispensing label and should be double-checked preferably evidenced by two staff signatures. F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 26 Lynden 4. 5. 6. 7. 8. YA20 YA24 YA24 YA24 YA17 Patient information leaflets should be obtained for all medicines and presented to staff for training and information The broken chest of drawers should be repaired The residents should be given guidance about fabrics that are available to dress the windows without taking away natural light Residents whose bedrooms are in need of decorating should be consulted as their choice of decore. A record should be maintained of all the meals provided to reflect an adequate diet. Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 27 Commission for Social Care Inspection Unit 1, Tustin Court Portway Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lynden F57 F09 S 9678 Lynden V198974 240505 Stage 4.doc Version 1.30 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!