Inspection on 01/05/08 for Lyndhurst

This inspection was carried out on 1st May 2008.

CSCI found this care home to be providing an Poor service.

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

Lyndhurst 29/10/08

Lyndhurst 04/12/07

Lyndhurst 10/08/06

Lyndhurst 16/05/06

Lyndhurst 19/12/05

Lyndhurst 21/06/05

Lyndhurst 12/10/04

Lyndhurst 24/05/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Lyndhurst 67 Byfleet Road New Haw Weybridge Surrey KT15 3JZ Lead Inspector Sally Hall Unannounced Inspection 01/05/08 09:30 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 Lyndhurst DS0000013707.V363094.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. Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lyndhurst Address 67 Byfleet Road New Haw Weybridge Surrey KT15 3JZ 01932 842730 01932 842730 lyndhurstchome@aol.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) Mr Aboo Bakar Seeparsand Mrs Zehra Bibi Seeparsand Mr Aboo Bakar Seeparsand Mrs Zehra Bibi Seeparsand Care Home 16 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (16), of places Physical disability over 65 years of age (3) Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The age/age range of the persons to be accommodated will be: 65 YEARS AND OVER One named indivivual DE(E) Dementia - 0ver 65 to be added to the registration for the duration of their stay at the home. 4th December 2007 Date of last inspection Brief Description of the Service: Lyndhurst is a large detached house in a residential road within walking distance of local shops and New Haw and Byfleet railway station. The building is Tudor style with car parking facilities to the front of the house and an enclosed mature garden to the rear. The home provides care for sixteen older people, ten of whom may also be diagnosed with dementia and three with physical disabilities. Bedroom accommodation is single with the exception of one double bedroom. Nine of the bedrooms have en-suite facilities. There is a large combined lounge and dining area and a conservatory overlooking the garden. There is a kitchen and separate utility room. The manager stated fees range from £365 to £480 per week. Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the Service was an unannounced “Key Inspection”. The Inspectors arrived at the Service at 09.30 and were in the Service for six hours. It was a thorough look at how well the Service is doing. It took into account detailed information provided by the Service’s owner or manager and any information that CSCI has received about the Service since the last inspection. The Inspectors Sally Hall and Ruth Burnham agreed and explained the inspection process with the Registered Managers at the start of the inspection. The focus of the inspection was to assess Lyndhurst in accordance with the Care Home Regulations 2001 and the National Minimum Standards for Older People. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. The Inspector used a varied method of gathering evidence to complete this inspection, pre-inspection information such as the previous report and discussion and correspondence with the registered provider was used in the planning process to enable the inspectors to explore any issues of concern and verify practice and service provision. The home had completed an annual quality assurance assessment questionnaire, which was received prior the site visit to the home. This provided the Inspector with information relating to what the home considers it does well, What it could do better, What has improved within the last 12 months and plans for improvement. We also took into consideration the improvement plan received in relation to requirements made at the last inspection. Documentation and records were read. Time was spent reading written policies and procedures, reviewing care plans and records kept within the home. Other area’s viewed included risk assessments, pre-admission assessments, staff rota, training records and recruitment records. The Inspectors identified five people who use the service for case tracking, speaking with one of them whilst assessing the available information held in the home pertaining to their care. In addition the Inspectors sat in the dining area adjacent to the lounge most of the day, which gave them a good opportunity to observe the quality of care being provided by the home’s staff and understand the impact the care provision has on peoples’ quality of life. There are Required Developments at the end of this Report. Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 6 The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. What the service does well: What has improved since the last inspection? Since the last inspection 14 bedrooms have been decorated, and some furniture has been replaced. The carpet has also been replaced in a number of rooms and the home now has an on going maintenance plan. The requirement made at the last inspection has been met. The chairs in the lounge have also been replaced as has the lighting which is far more pleasing and of a domestic nature now. The sky light in the lounge had been replaced affording more light to the area. The requirement made at the last inspection has been met The care plans have improved and give clear instructions to staff on how each person is to be cared for. These are also reviewed monthly. The requirement made at the last inspection has been met There is a programme of activities throughout the week, however more needs to be done to facilitate activities tailored to the individual person. There was no longer an odour detected within the home and areas seen appeared generally clean. The requirement made at the last inspection has been met Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 7 Since the last inspection the staff have received a lot more training and now most have completed the required courses and undertaken training in other specialised areas to ensure they can meet peoples’ needs. The requirement made at the last inspection has been met Staff are now all receiving supervision on a regular basis and this is well documented. They have also received an annual appraisal; this information is being used to plan training for the year ahead according to the AQAA. The requirement made at the last inspection has been met The registered managers have given out two surveys since the last inspection, they asked for views on catering and activities, however the responses have not been analysed and formal feedback was not available. The registered managers stated in the AQAA that they intend to devise a questionnaire that will be easier for the people who use the service to complete. This questionnaire will cover more topics within the home. What they could do better: It is important that when undertaking an assessment of a possible new person that all the information from all the health professionals be taken into consideration. For the last person to be admitted, important information was not considered. Care plans should be re written as peoples’ needs change so that staff have up to date guidance on how to meet peoples’ current care needs, rather than just making reference to it in the care plan review. Although the home has the appropriate equipment for moving and handling, it has still to provide a safe system for moving and handling service users. Staff were once again seen trying to move someone in an inappropriate way. The staff have had training however the registered managers have now arranged for the trainer to come to the home to advise staff. More understanding is needed of each person’s background and social history, likes and dislikes and wishes around hobbies and activities to make sure they have the choice of stimulation to suit them as individuals. Medication needs to be kept under constant review by the GP and with the advice of the supplying pharmacist to ensure that the risks of falls and or sleeping excessively associated with Poly-n pharmacy (more than six medicines currently prescribed and taken) are managed appropriately. A large number of people who use the service slept the majority of the day, whilst it is recognised that older people do fall asleep during the day staff had problems waking people for meals and drinks. A requirement has been made regarding Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 8 this that the advice of the pharmacist, dispensing Chemist and GP be sought with a view to reviewing these peoples medication. The first aid box kept in the home needs to be checked regularly so that in a first aid emergency staff have the equipment they need, items missing should be replaced, open boxes of dressings should be removed and the storage area and boxes must be kept clean. The registered manager states that 80 of the care staff are undertaking an National Vocational Qualification level 2 or 3 in care, it is important that these courses are completed in a timely manner to ensure that people who use the service are looked after by people who have a qualification in care and are able to demonstrate they can meet peoples’ individual needs. The policies and practice in the use of gloves to prevent the spread of infection must be monitored. Current guidance from the Department of Health on the prevention of allergies and the spread of infection should be included in the homes written policies and followed by staff. 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. Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 9 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 Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 10 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): 3, The people who use the service experience adequate outcomes in this area. People who use the service cannot be fully confident that all their previous history will be considered when a place at the home is offered, this could mean that the home may not be able to meet all their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The file for the last person to be admitted to the home was read; personal details, medical history in brief and next of kin were recorded. The preassessment seen covered, for example, personal hygiene, nutrition, continence, social stimulation, weight loss, feet and skincare, and cognitive impairment. This person came to the home from hospital, and had several assessments; social services and multidisciplinary. Documents included information from the mental health team and the hospital discharge notice. Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 11 These all gave a picture of what had happened to the person before they were referred to the home. Unfortunately important information included in these documents had not been recorded in the home’s original assessment and initial care plan. This could mean staff do not have appropriate guidance and information to provide person centred care or protect the person or others from harm. The homes training record, indicates that most staff are given courses in subjects such as Mental Health issues for older people, protection of the vulnerable adults, understanding dementia, management of constipation, mouth care, stoma care, plus the statutory training required. These courses have been undertaken to ensure that staff are able to meet the needs of the people currently living at the home. Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 12 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. The people who use the service experience poor out comes in this area. The people who use the service cannot be confident that their health, personal and social care needs will be recorded in the plan of care. Care Plans are however regularly reviewed and outcomes recorded. People who use the service could be at risk however as not all risk assessments are reviewed to reflect changes in their situation. People who use the service can be fairly confident that they will receive the medication that they are prescribed. People who use the service have their dignity respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspectors sampled files for a total of five people who use the services files; looking at the assessments, care plans, the review of those plans, risk Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 13 assessments, personal histories, and the daily records kept about each person who uses the service. The detail contained in the care plans reflected the assessments undertaken. The care plans were well written and explained the area of care and what staff action is required to ensure the people who use the service are well cared for. Some of the care plans indicated that people who use the service had been involved, or their relative or advocate in the formation of the plans. Each item within the plan such as personal care, nutrition etc. had been reviewed separately every month. However not all changes are resulting in updated plans of care to provide current guidance for staff to follow. It was apparent for example that the care needs of one person had changed following a stroke, this had not resulted in an updated care plan, and changes had only been recorded on the review sheet. All people who use the service have their weight recorded on a monthly basis and there was evidence that weight is monitored by the home. This enables staff to identify whether the person is eating a healthy diet that is sufficient for their needs. Each person has a moving and handling assessment but in some records this was not comprehensive and could compromise the safety of residents. Information, which was missing from one care plan, would have, if included, shown that there was an increased risk to the person when being moved or handled by staff. The daily records were completed for each person but these did not contain details of all events and care given with the times that things occurred, rather it was a general overview of the day. The manager rather than care staff at the home writes the daily report. There was nothing recorded about things that happen during the night hours. Events during the night are written in a diary by the staff on duty but it contains very scant detail. Personal information is recorded in the diary rather than being recorded on an individual basis in contravention of the regulations and the Data Protection Act 1998. Risk assessments were seen apart from those for the moving and handling; these included a falls risk assessment. People are being placed at risk where their care needs change and risk assessments are not being reviewed or updated to reflect the changing needs. The home keeps a record of GP and hospital visits with the outcomes. Evidence was seen that visits are arranged for the chiropodist, optician and dentist to visit people in the home. Medication is kept in a locked trolley in a locked room. The manager confirmed that no one is currently prescribed medications that are known as controlled medication. Should controlled medicines be prescribed in the future the manager should review the medication storage to ensure it is in line with the recently issued guidance. The inspectors looked at the medication kept in the Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 14 home, It found that of the six items sampled two medications that are given PRN (when needed) had not been signed for correctly, in both cases these medicines had been signed for as given when they had not. The majority of medication however is delivered in a blister packed dispensing system. These were administered correctly. The MAR (medication administration record) sheets were fully completed, with people’s personal details and there is a record kept when new medication is received into the home. Concern was raised with the managers that there were a number of people who use the service who appeared to sleep all day during our visit, and had problems staying awake to drink a cup of tea. One person who uses the service had been prescribed medication for agitation; this was not being administered in accordance with the doctor’s prescription. The managers were advised that medication needs to be kept under constant review by the GP and with the advice of the supplying pharmacist to ensure that the risks of falls and or sleeping excessively associated with Poly- pharmacy (more than six medicines currently prescribed and taken) are managed appropriately. The managers were asked to review this and other peoples’ medication with their pharmacy. All staff who have been trained to administer medication had given a sample of their signature on the front page of the MAR sheet folder. The managers confirmed only those staff and they are allowed to administer medication in the home. They also confirmed that the managers undertake an audit on a regular basis. Storage of medication in the trolley cupboards and refrigerator was observed to be appropriate. The medication room has a drugs fridge and the temperature is recorded regularly to ensure medication is stored with in the correct temperature range. The items found in the fridge were in date and were correctly marked with the date they were opened, this is important as a number of items that need storing in the fridge have a limited life once opened. Observation of the staffs practice with regards to maintaining privacy and dignity, took place, as many of the service users are unable to express how their care is delivered. Generally the staff interacted appropriately with the people who use the service. All personal care was done out of sight of other people who use the service and visitors. One visitor spoken to confirmed that people who use the service are treated with respect and their dignity respected at all times. Concern was raised by the inspectors about the way people who use the service were moved from one place to another. The moving and handling techniques being used were not in accordance with good practice and placed the person at risk of harm. The inspectors intervened to protect the person Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 15 from risk of harm and drew the poor practice to the attention of the person in charge of the service. The managers have now arranged for the moving and handling trainer to visit the home to demonstrate to staff how to put techniques learned into practice with the people who live in the home. Plastic covers for the mattress and pillows with thin bed sheets and pillowcase covers are used on all beds, not just where the service user has been assessed as having continence care needs. The managers were advised that, not only are these products hot, noisy and uncomfortable but use of these products could increase the risk of pressure damage to frail skin. Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 16 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. The people who use the service experience adequate outcomes in this area. People who use the service can feel confident that there are a number of activities that they can take part in during the week and their family and friends will be made to feel welcome. People who use the service are offered a choice from a nutritious menu, with snacks and drinks offered and available between meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who use the service’s records were sampled, although they contained some personal history, this was not as detailed as it could have been and did not give a full picture of the individuals preferences to inform staff about the kind of activities they may like to be part of. The activity programme for the week is recorded in every persons care plan. The AQAA states that the manager has started work on individual files for activities and is going to try and increase the information they now have. At the moment the activity programme recorded on the files currently still records the same activities for all and are not based on the persons personal preference. The manager has started to change what activities are provided for one person but this is not at Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 17 present recorded in their care plan. The activity programme intimated that people who use the service do walk down the shops sometimes during the week; currently this is not recorded in the individuals’ Care Plan Visitors spoken to confirmed that they are always made to feel welcome when ever they visit the home. One explained that she often sees activities occurring during the week. However she also said that a lot of the people who use the service sleep through what is going on. She said that she could see her relative in private if she wishes, but generally is happy to sit in the lounge with everyone else. Evidence was seen in the care plans of guidance about how staff should promote independence. Care plans stated that people who use the service should be given the opportunity to choose what they wish to wear for the day, what they have for breakfast and if they want to join in the activities for example. During the lunchtime meal a staff member was seen to put this into practice by encouraging a person to eat their meal themselves. The midday meal seen looked appetising and was well received by the people who use the service. The cook had offered a choice and three of the people who use the service had something different from the menu. The portions looked appropriate and more was available if wanted. People who use the service who were asked said that the meal was very nice. The menu showed that the there is a choice on a daily basis, although most of the people who use the service chose the same things most days. The menu was used to record what people in the home ate. Poor practice was observed where one member of staff who was assisting a service users with their meal was standing over them rather than sitting comfortably beside them and making eye contact so enhancing the shared experience and preventing back pain in the member of staff. The member of staff also had to keep waking her up to ensure the meal was eaten. The mid morning drink, tea or coffee was seen given to people who use the service, and, because some of them were asleep, the drink was removed again without being drunk. This was made known to the registered managers, as it is important that older people get plenty to drink throughout the day. Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 18 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 & 18 The people who use the service experience adequate outcomes in this area. The people who use the service and their family or advocates can feel confident that any complaint will be taken seriously. Staff are trained to recognise and protect people who use the service from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the complaint procedure was seen displayed in people’s bedrooms. Where the person who uses the service has dementia it can be the family or advocate who would initiate a complaint. The home has not had any complaints in the last year. The way complaints are recorded needs to be reviewed as recording personal information in a document used for several people is not in accordance with Data Protection legislation Although the policies and procedures were not viewed during this inspection the AQAA (Annual Quality Assurance Assessment) stated that all staff have had the appropriate protection of vulnerable adults training. The AQAA provided prior to the inspection does not currently refer to the use of Independent Mental Capacity Advocates (IMCA ) which are now required due to the introduction of the Mental Capacity Act . Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 19 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. People who use the service experience adequate out comes in this area. People who use the service can feel confident that the home will be generally clean and free from odour. Work on refurbishing the home and providing new furniture is not yet completed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Both inspectors undertook a tour of the building. It was evident that a number of improvements have taken place since the last inspection. New furniture was seen in some of the bedrooms and new flooring in toilets and bedrooms was seen. The home is now free from odour and a much more pleasant place to live. The AQAA states that there is still much to do, as there are still areas that Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 20 look tired and are in need of redecoration. One room that has been done recently was not done to an acceptable standard with areas of the paintwork showing the previous colour in patches around the room. The home was clean, however some surfaces compromised infection control as paintwork or varnish was chipped or worn away. The quality of the bed linen appeared poor and there was a mismatch of colours and styles in rooms around the home. Most rooms had been personalised by the people who use the service and their families. Some rooms had en-suite facilities. The toilets in the home had toilet rolls on a pole that stands on the floor or ledge, they would be difficult for the people who use the service to reach themselves, and reaching for them could cause a fall. Two bedrooms interlink, and are occupied by people who had not chosen to share. Bedrooms should be able to be locked for privacy and a key supplied if appropriately risked assessed. The manager confirmed the fire officer has been consulted and in their opinion to lock the door would not compromise the safety of people using the rooms as a fire exit. The windows have restrictors to allow ventilation without any risk to the people who use the service. Fire exits are clearly labelled, and some exits are through peoples’ bedrooms, here the staff must remember to keep the walkway clear as furniture was obstructing the rout to one fire exit. The lounge and dining room lead on from each other; off the lounge there are toilets and several bedrooms. A conservatory also leads off of the lounge and it is accessed via ramps. This looks over a very pretty and well-kept garden. The conservatory cannot be used all year round, as it does not have any heating. The laundry was not seen during this visit. Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 21 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. People who use the service experience Poor outcomes in this area. People who use the service can be confident that there will be trained staff in sufficient numbers to meet their needs. Staff are not currently employed in a way that ensures they are safe to work with Vulnerable people. Not all staff have had the required checks by the Criminal Records Bureau or POVA first checks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four staff files were sampled including two new care staff and a domestic member of staff. All files contained an application form and the majority of the documentation required. It was noted that the letter confirming two students had the appropriate permission to work and study was not seen on file, however a copy has now been received at our office. The two new members of staff had been introduced through a training company and they are studying National Vocational Qualification level 3 and 4 in care. Both have previous experience of working in the caring profession in there home country. References have been obtained from those countries. It was noted that the POVA first check and the CRB (Criminal Record Bureau) check were not done prior to persons commencing work. In one case a record Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 22 that the check had been received back was not evident on the file. The manager confirmed that he had not documented this person’s check in the file as required by regulations. The rota was seen, three care staff are on duty through the day with a registered manager supervising and working with staff. There is a domestic member of staff on daily, plus the cook. At night there is a member of staff who sleeps on the premises in case of emergencies and a member of staff who stays awake to look after the people who use the service. This situation should be reviewed regularly in consultation with the Fire Office to ensure that the Fire risk assessments are robust and meet the needs of their legislation. The manager has arranged a number of training courses since the last inspection to ensure that staff have the required courses and they are in date. However the manager did say that he did not have a qualified first aider, There must be a qualified first aider on duty at all times. The majority of the training records seen for staff did show that the majority now have most of the training they require. It is important that these courses are refreshed at the recommended intervals. Staff have also done some more specialised courses to ensure they have the skills required to meet the needs of the people who use the service within the home. There are 70 of the staff currently undertaking an National Vocational Qualification level 2 or 3 in care. The home does arrange for it’s new staff to have induction training, which meets the standards required. The staff have booklets, which they must get signed off when they are competent at a procedure or task. However two books were seen for staff that have been at the home over a year and these have not yet been completed. Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 23 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, 33, 36, 38. People who use the service experience Poor outcomes in this area. Through the training and policies and procedures the home ensures that people who use the service and staff remain as safe as possible. Records of equipment maintenance are not all up to date. People who use the service cannot be confident the their views will be listen to and used to improve the service provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The managers, who are also the registered providers, have the relevant qualifications and experience to manage the home. Evidence seen and observation show that as at previous inspections the managers are willing to do what inspectors discuss with them, this is a very reactive approach and Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 24 management should be seen to be more proactive. Regulation requirements made at the last inspection of which there were many have largely been met. The AQAA demonstrates these changes but in several areas the compliance is minimal. There is now evidence that the home is surveying people who use the service for their opinions about the home and the service they provide. So far this covers the activities and the catering within the home. The managers had not evaluated the information, used the information given to write a feedback sheet or used it to improve the service they provide. At least 2 people had responded negatively to questions about catering in the last survey, their comments had not been noted or acted upon. The AQAA states that they have reviewed this system and intend to devise a simpler questionnaire, which will be easier for the people who use the service to complete, and that they intend to use responses to improve the service they provide. On the day of inspection the boiler was being tested, the electrician had been booked as the safety certificates, along with the fire equipment, and others ran out in April (over a month previously) this year. Staff have done most of the required mandatory training, i.e. Health and safety, infection control, basic food hygiene, and moving and handling. However concerns were again raised during the inspection about the way staff were trying to transfer a person who uses the service from their chair to a wheel chair. The manager explained that he would follow this up with the staff and trainer. This he has done with the trainer agreeing to come to the home. The first aid box seen had items in open boxes and did not contain all the items recommended in it. There were two boxes, one that did not look very clean or hygienic. The manager also confirmed that the first aid certificates had run out and he needed to arrange a new course as soon as possible. Policies and procedures have been reviewed within the last year, however the managers are aware that there have been changes in legislation and intend the review some of the policies again soon. Evidence was seen that staff are now having regular supervision which is well documented, they have also had an annual appraisal. Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 25 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X X 3 X 1 Lyndhurst DS0000013707.V363094.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 OP7 Regulatio n 12(1) (a) Requirement The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users; in that personal care must be provided in a safe and appropriate manner. The registered person shall make suitable arrangements to provide a safe system based on risk assessments for moving and handling service users. Also that all staff must be repeatedly monitored to ensure that training received by staff is then embedded into good care practice. The registered person shall make suitable arrangements to provide a safe system for moving and handling service users. In that all staff must be trained to move people safely using the appropriate equipment. The registered person shall make arrangements for the recording, DS0000013707.V363094.R01.S.doc Timescale for action 02/07/08 13(5) 2.. Lyndhurst OP9 13.2 02/07/08 Page 27 Version 5.2 3. OP29 Schedule 2, 7(a) 4. OP38 13.4(a) 5. OP38 13.4( c) 7. OP9 13(2) 8 OP7 13(4)(c) handling, safekeeping, safe administration and disposal of medicines received into the care home. The giving of prescribed PRN (as required) medication must be in accordance with the doctors prescription and reviewed at the times specified by them. The registered person(s) must ensure that all staff employed in the home, have an up to date record on file in the service that contains the information required in the schedule and that all staff have received their enhanced criminal record certificate(CRB) and POVA information, prior to starting work in the home. The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety, i.e. With fire exits being kept clear Unnecessary risks to the health or safety of service users are identified and so far eliminated, and shall make suitable arrangements for the training of staff in first aid. The giving of prescribed (as required) medication must be in accordance with the doctors prescription and reviewed at the times specified by them Unnecessary risks to the health and safety of service users are identified. Risk assessments must be undertaken and reviewed at appropriate intervals and action taken to eliminate or manage the risk. In that Care Plans must be kept updated to show those risks and how they will be managed, by care staff. DS0000013707.V363094.R01.S.doc 02/07/08 01/06/08 31/08/08 31/08/08 02/07/08 Lyndhurst Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP3 OP7 OP38 OP7 Good Practice Recommendations Pre admission assessments should include the information form other health professionals where it is relevant. Review the use of plastic sheeting given that this can increase the risk of poor skin integrity. Put in place a system to ensure that maintenance certificates are renewed before they go out of date. The connecting door between two people who use the service on the ground floor should be locked, subject to the approval of the fire safety officer, to ensure the privacy of the occupants. The programme of activities should be extended to record on individual care plans those activates planned and taken up. The provider is to ensure that the records show that the activities have been planned taking into consideration the interests of the individual and is appropriate to their assessed needs. In that the home must seek advice about current good practice and appropriate activities for service users with dementia, to ensure their needs are met sufficiently. Where service users are observed to be less wakeful and who may have been prescribed more than six individual medicines (poly-pharmacy) good practice requires that the person administrating that medication requests a review of the service users medication by the doctor and dispensing chemist to ensure its appropriateness. 5. OP12 6. OP9 Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Lyndhurst DS0000013707.V363094.R01.S.doc Version 5.2 Page 30 - 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. 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