Inspection on 27/06/06 for Lyndhurst

This inspection was carried out on 27th June 2006.

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

Other inspections for this house

Lyndhurst 26/10/05

Lyndhurst 20/04/05

Lyndhurst 22/09/04

Lyndhurst 04/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Lyndhurst College Street Leigh Wigan Greater Manchester WN7 5QH Lead Inspector Lindsey Withers Key Unannounced Inspection 27th June 2006 08:35 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 DS0000005747.V295432.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 DS0000005747.V295432.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lyndhurst Address College Street Leigh Wigan Greater Manchester WN7 5QH 01942 606319 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) 01942 671246 jan.pickup@clsgroup.org.uk www.clsgroup.org.uk CLS Care Services Limited Ms Janice Pickup Care Home 40 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (40), of places Physical disability over 65 years of age (8) Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 40 service users to include:up to 40 service users in the category of OP (Older People) up to 8 service users in the category of PD(E) (Adults with Physical Disability over 65 years) up to 3 service users in the category of DE(E) (Adults with Dementia over 65 years) The service should employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection. The Home’s Statement of Purpose must be altered to set out how the services and facilities offered by the Home will meet the needs of service users with dementia by 31 May 2005. The Registered Person must ensure that all staff working in the Home have dementia training awareness and dementia care training, which equips them to meet the assessed needs of the service users accommodated, as defined in the individual plan of care. The service must at all times employ suitably qualified and experienced members of staff, in sufficient numbers, to meet the assessed needs of the service users with dementia. 26th October 2005 2. 3. 4. 5. Date of last inspection Brief Description of the Service: Lyndhurst - part of the CLS group of homes - is situated close the centre of Leigh, near to shops and other essential services. A large three storey buildings, residents are accommodated on each floor. Throughout the building there are a number of lounges and seating areas, and there is a separate visitors’ lounge. The main dining room is located on the ground floor. Each of the 40 bedrooms is for single occupancy. There is limited outside space. However, the courtyard garden is secure, well-maintained and attractive. There is limited car parking for visitors to the home; however, a pay and display car park is located within a few minutes’ walk. Lyndhurst offers accommodation to people aged 65 and over, who require assistance with personal care. The fees at Lyndhurst are currently £370 per week. Additional charges may be made for residents’ personal spending, such as toiletries, clothing, etc. Further details can be found in the home’s Statement of Purpose. Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection was to look at the main “key” standards in order to assess the level to which Lyndhurst meets the needs and expectations of residents. This inspection involved an unannounced site visit to the home on 13th June 2006 from 8.35 a.m. to 4 p.m. Part of the time was spent looking at the paperwork that the home needs to keep to show that it is being run and managed properly, and part of the time looking around the home and watching how people are cared for. The inspector also joined five care assistants and the Manager at their planned meeting. In order to get a wider view of life at Lyndhurst, as well as speaking to residents and staff at the home during these site visits, the inspector has taken account of comments cards that had been returned to CSCI from residents and relatives. No comment cards were returned from health and social care professionals, such as GPs and nurses. In making the judgements contained in this report, the Inspector has also considered previous inspection reports, and any other visits that were made to the home. What the service does well: Lyndhurst is a well-run, well-managed home where residents are accommodated in comfortable surroundings. The care provided for residents is based on looking at what each individual person needs to live as independently as possible. Care plans state what each person is able to do for themselves, as well as where they might need some help and support from people who work at the home. Residents are encouraged to choose how they spend their lives, and help is given where it is needed or asked for. Meals are very much enjoyed by residents, and care is given to those who need special diets. Complaints and concerns are treated seriously, and the Manager and the staff team will look to see where changes and improvements can be made. The home is staffed by people who have been properly recruited and who are suitable to work with older people. Staff are interested in the work they do and understand their responsibilities. They show an interest in training so that they can provide a better service for residents. The Manager and the staff team have a clear understanding of their responsibility to keep the residents and themselves safe. In sharing their views with CSCI, residents and relatives were complimentary about the quality of care delivered by Lyndhurst. One person wrote in her comment card, “(My relative) could not be in a better home.” Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 6 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 contacting your local CSCI office. Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 7 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 DS0000005747.V295432.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this home. Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. A full assessment is carried out prior to admission, the result of which forms the basis of the residents plan of care. Only people whose needs can be met at the home are admitted. EVIDENCE: The files for three recent admissions were looked at, one of whom was a person taking a period of short term (respite) care, and one person had transferred from another CLS home that had closed. Assessments had been completed, which looked at the different areas of need for each person. Special needs, such as a person’s restrictive movements after a stroke, or because of arthritis, were noted, together with information on the extent of the help that was needed, for example, from one or two carers. The same assessment process had been followed for each residents, regardless of their intended length of stay, which meant that as much information as possible was gathered by the home to make sure the person’s needs could be met. One of Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 9 the residents was heard expressing their satisfaction with Lyndhurst to a visitor. Where social services have been involved in arranging the person’s admission, a copy of their assessment is kept on file. These contribute to the home’s assessment process, and help to determine whether Lyndhurst can meet the person’s needs. The files show where the proposed resident’s family or other supporter has been involved in the pre-admission assessment. 3 comment cards were returned to CSCI from residents. Two people said they had received enough information about the home before moving in, and one person could not remember. Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence, including visits to this service. Each resident has a plan of care that sets out the person’s health, personal and social care needs. Improvements in reporting and in recording the signatures of residents or their supporters will make care plans better and show they are satisfied with the plan of care. Residents have access to the quality of care that is appropriate to them, including community and hospital services, and any risk to the individual is assessed. Medication is managed properly. Residents are kept safe by the home’s procedures and practice. Residents can be assured that they will be treated with respect and that their right to privacy will be upheld. EVIDENCE: The files for three people were looked at. One person was staying at Lyndhurst for a short period time, and another had transferred from a CLS home that had closed. Each person had a plan of care that looked at the different areas of need, identified what the problem or expectation was, and, for the most part, set out the action to be taken. What had been found in the Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 11 assessment had been put into the plan, and the plan had been adapted and changed so that it still suited the resident. For example, one person’s health had improved to the extent that they no longer needed to be seen by the dietician. The monthly reviews clearly showed improvements in the person’s eating and drinking habit, and the consequent weight gain that the dietician had hoped for. The care plan entries were written as if stated by the resident, for example, “I like to...”, “I need ...”. One member of staff had written the monthly review in the same way, for example, “I have no changes to make to my written plan.” and it would be better if all reviews were written in this way if the home is to demonstrate in writing the person-centred approach to care it strives to achieve in practice. There was good evidence in care plans to show that residents have made requests of the doctor or other health professional, and entries by staff to show that families have been consulted with about the care planning process. However, no-one other than care staff have signed the three care plans examined. One person is very independent, and the Manager said that staff have gone through the care plan with this person. However, the person had not signed – in the space provided – to confirm acceptance. If residents (or their supporters) were to do this, the home would be better able to demonstrate their involvement in planning the care that is to be delivered. Staff must take care to ensure entries are always dated, including on documents relating to risk assessments. Staff must also take care to ensure actions identified from reviews of care plans are followed up on. For example, one person’s requested registration with a dentist had not been completed, nor was this person’s express wish to follow a hobby although the Manager said some work had been done. In this last instance, if the home is to be able to demonstrate that it seeks to maintain a resident’s current skills (and to revive past skills, if this is the wish of the resident), then entries in the documentation will need to be better. All residents living at Lyndhurst have given over responsibility for medication to care staff. No-one is currently self-medicating. Medication is managed by Care Team Leaders who have received appropriate training. CLS introduced a new policy that related to the safe handling of medicines in March 2006, which staff have been trained in. The morning medication round is lengthy, not least because a number of residents take a high number of medicines at this time. The Care Team Leader on duty said that the medication given out at other times was much less. The Manager said that she was in discussion with the Care Team Leaders with a view to improving the way the lunch and dinner medicines were dispensed, so that they were given out after meals (unless the GP advised differently). This would mean that residents were not interrupted when they were eating. Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 12 Medication records are completed at the time the medicine is given out, and staff supervise residents to make sure all medication is taken. Staff will speak to doctors when they visit residents and ask them to review the resident’s medication, so that, so far as possible, residents only take the minimum medication necessary for good health. There were good examples in evidence of residents being treated and respect and dignity during the time of this visit. Staff spoke kindly and quietly, for example, “Can I put this on for you?”, “Shall I walk with you?”, and reminders were offered in such a way that the resident would not be offended. Staff were seen to be covering ladies’ knees, and speaking discreetly to residents about personal hygiene. One carer, however, did make an inappropriate comment to a resident, which was overheard by the inspector and which was reported to the Manager. Residents said their clothing was always washed nicely and returned to them quickly. Care assistants at their meeting emphasised the need for residents’ clothing to be labelled so that it does not go missing, and so residents only wear their own clothes. They discussed the options for residents coming to stay for a period of respite care, for example, zipped net bags and stick on labels. As some short term residents normally live at home, their clothing is not usually labelled. Three comment cards were received by CSCI from residents. All said they “always” receive the care and support that they needed. One person said they only “sometimes” receive the medical support they needed, but two people said they “always” receive it. In a comment card returned to CSCI, a health professional expressed general satisfaction with the service provided at Lyndhurst but referred to “one episode of mistake in giving medication” (This had been notified to CSCI and had been dealt with appropriately.) Five comment cards were received by CSCI from relatives. All five expressed satisfaction with the overall care provided at Lyndhurst, stating that they were kept informed and consulted with about the care of the resident. Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. There is an activities programme that meets individual and group needs, but staff must take care to keep accurate records. Residents are encouraged to maintain skills for as long as possible. Visitors are made welcome and can call or telephone at any time. Residents are helped to exercise choice and control over their lives. They are offered a healthy, nutritious diet that respects individual preferences, and are helped to ensure they take sufficient food and drink. EVIDENCE: The home has a monthly events list that lets residents and visitors to the home know what entertainment or excursions will be taking place. There is also a weekly activities list that shows what will be offered on a daily basis. The Activities Organiser works from mid-morning to mid-afternoon on four days of the week, and from 4 – 9 p.m. once a week, so that activities can be provided at times that are suitable to the residents. Plans are in progress to provide a games table in the conservatory where residents can enjoy a game of cards, dominoes, etc. without having to wait for it to be “on the list”. A Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 14 good number of residents at Lyndhurst are largely independent and go out and about with family and friends. Some like to spend time in their rooms, but the majority prefer to spend time in the lounges where they can meet with other residents and where there is more contact with staff and other visitors to the home. One or two residents do some household chores on a daily basis, and one resident joins the domestic staff at their morning meeting. The Manager and the Activities Organiser try to make sure that all residents are offered the opportunity to take part in activities and excursions, the extent of which is recorded in the activities file. The Prayer Room has been closed and converted back to a bedroom. Residents liked the quiet space that the Prayer Room offered, and the Manager has identified a small lounge on the top floor where artefacts from the Prayer Room are kept, and where religious services can be held. The breakfast and lunch-time servings were observed on the day of this visit. Tables were nicely presented and the atmosphere convivial. Residents were offered choices at both meals, and staff were observant, encouraging residents to take a good diet and offering help where it was needed. Residents said that the food was “very good”, that they had “enjoyed the meal”, and that there had been “plenty to eat”. One resident told the inspector that the food was “always good”. There was evidence in the care plans to show that residents had seen a dietician or someone from the speech and language therapy team, if the need arose. Supplements are arranged via the GP for those residents who need extra help with their dietary intake, and eating aids, such as plateguards, are provided as needed, to help residents eat independently. Three comment cards were received by CSCI from residents. All said that there were “always” activities that they could take part in, and that they “always” like the meals at the home. Five comment cards were received by CSCI from relatives. All said that they were made welcome in the home at any time. Four people said they could visit their relative in private, but one person said they could not. Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. The home has a complaints procedure, details of which are given to residents and their relatives on admission. The home has a policy and procedure for dealing with allegations of abuse. Care practice protects residents from harm. EVIDENCE: The home’s complaints file contained two that had been received since the last inspection by CSCI. The first raised a number of issues with which the complainant was unhappy, such as cups being left around the home and dead flowers not being removed, and also matters that related to the resident living at Lyndhurst, such as the resident not wearing co-ordinated clothing, and the complainant’s disagreement with the optician’s decision. The Manager had addressed all matters, and a record had been kept of the agreed decisions. The second complaint concerned matters that had been referred to the local authority’s Adult Protection team. Meetings had taken place, lead by the local authority social services department, and the conclusion was reached that Lyndhurst did not neglect or abuse the resident in any way. Although the allegations against Lyndhurst had not been upheld, the Manager and staff at the home felt they could learn something from the experience, and Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 16 make changes to working practice so that a similar situation could be avoided. For example, no resident is allowed to return to Lyndhurst from hospital without having been re-assessed by the Manager or her representative. Care assistants were very clear about their responsibilities. During their meeting on the afternoon of this visit, which five care assistants attended, they said they would have no hesitation in bringing to the attention of management - or other organisation, if appropriate – if they felt that a resident was at risk of abuse or neglect. Two members of staff said they had “blown the whistle” in their previous jobs because care practice had been unacceptable. Staff of about learning about the protection of vulnerable people during their induction period at Lyndhurst, during the National Vocational Qualification training, and during periodic update sessions. The Manager said the topic of avoiding abusive situations is discussed periodically during handover – for example, at a time when a resident was unwell and unusually agitated – and during staff supervision sessions. She is also mindful that staff can become less patient when tired, and monitors the rota to make sure staff are not working too many hours over and above their contracted hours. The CLS guidance booklets for residents and staff are displayed on the main noticeboard, together with information on how to contact an advocate. During the course of this site visit, residents were seen to approach staff with a query or a concern. Staff were responsive and stopped what they were doing to listen, so giving the resident full attention. Three comment cards were received at CSCI from residents. One person was not sure whom they would speak to if they were unhappy, but two people said they would speak to a senior member of the care staff. None of the residents said that they knew how to make a complaint, but one person said they “would ask about it”. Five comment cards were received at CSCI from relatives. Four of the five were aware of the home’s complaints procedure, but one person was not. None of the five relatives had ever had to make a complaint. Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including visits to this service. Residents live in a comfortable home, that is clean and well-maintained. However, furniture transferred from another CLS home is worn, dirty and stained and needs to be removed. Planned improvements to the garden will make the outside space better for residents, but accessibility by residents must be a consideration of the planning process. Staff are knowledgeable and understand what constitutes good infection control. Care staff will ignore budget demands and inaccurate instructions that have the potential to put residents at risk. EVIDENCE: This visit started at 8.35 a.m. and finished at 4 p.m. During the period of this visit the home was clean throughout, and there were no unpleasant odours. Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 18 Some furniture had been transferred from another CLS home that had closed, but this furniture – most notably easy chairs – were worn, dirty and stained, and smelled of hair grease and stale urine, to the extent that the odour stayed on the clothes. The Manager said she had not wanted to take them, but felt she had to. They contrasted with the 15 new chairs that had been purchased and with the existing Lyndhurst chairs. The Manager said that 12 more chairs have been ordered. It is not acceptable that residents are expected to sit on chairs in a poor type of condition. Some of the coffee tables (also inherited) are scratched and stained and must be renovated or removed. Around the home, ornaments, photos, postcards from holidaymakers and the like are displayed on shelves and table tops. Residents leave their personal items beside their chairs, so you will see bags, newspapers, crossword books, cardigans. and spectacle cases lying around, which gives an impression of comfort, domesticity and ownership. Lyndhurst has received a generous donation of coffee tables that appear sturdy and that are a useful size. The grounds are limited in size, but the courtyard garden is kept tidy and there is a good selection of plants and shrubs. Residents spoke about the plans to have some trees cut down so that extra outside space will be created, as well as creating more light in the main lounge. This will be better for residents who said that space had been at a premium at the recent strawberry scone coffee morning. Staff said that manoeuvring wheelchairs and zimmers in this small space had been time-consuming and needed good organisation. The Manager said they had received a donation and were intending to use this to improve the garden. When making these improvements, access to and around the outside space by residents must be taken into consideration. At the care assistants meeting, staff spoke about the importance of using the correct bags for transporting laundry. They made a request for protective clothing, such as latex gloves and aprons, as well as sanitizing fluid to be available in the sluice on each floor so that they are immediately to hand when needed. The Manager agreed to this. Staff said that a recent exercise to reduce the number of gloves used each day had forced them to hide gloves, which the Manager confirmed they did not need to do. A care assistant revealed that they had been given an instruction to wash gloves between uses. This instruction had been ignored by the care staff, an action that the Manager agreed with. The Manager said she would try to find out who had given the instruction, and make sure the person understands that this action would not be satisfactory as it is not a safe way of working. Information was left with the Manager regarding the Department of Health’s latest guidance on Infection Control, issued June 2006. 3 comment cards were received by CSCI from residents. All said that the home was “always” fresh and clean. Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, and 30 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. The home has an appropriate number of staff who have a range of skills. Residents can be sure there will be sufficient numbers of staff are on duty at all times. The home has 57 of care staff with NVQ level 2 in care. Staff are aware of the quality of care that they must provide. The recruitment process is robust. Only people who are suitable to work with older people are employed. However, some consideration needs to be given to making the male/female make-up of staff better and more equal to that of the residents living at the home. Training is arranged to ensure all people caring for the residents are competent. EVIDENCE: After a period of some stability, there have been a number of changes to the staffing profile at the home. Some of this has occurred as a result of staff being promoted within CLS, and some as a result of people leaving or retiring. Furthermore, some staff are being trained to move to more responsible roles, which means they are sometimes not available to work their regular shifts. The staff rotas are drafted through to the end of the year, but, realistically, are made firm two weeks in advance, to take account of holidays, training, and other planned leave (for example carer leave). During the day, one Care Team Leader and three care assistants (one of whom may be a senior carer) Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 20 are on duty to care for a maximum of 40 residents. Occasionally, there may be a person working supernummary to the rota, for example, during a training or induction period. There is some flexibility in the start times of each shift, which makes it more likely that extra people are on duty at busy times, such as first thing in the morning and at handover from one shift to another. For example, two members of staff start at 7.30 a.m. when they are rostered on. The practice of employing two care workers on duty overnight continues, but the Manager was able to demonstrate that additional staff are brought on duty at a time of need, for example, if a resident is unwell and needs individual care. Staff tend to cover for each other when there are gaps on the rota. Reliance on agency workers is kept to a minimum because staff say it is better for the residents to have people caring for them that they know. However, the Manager reminds staff about health and safety issues such as stress and fatigue that can be brought on by working too many hours (as was discussed at care assistant’s meeting), as this could potentially affect the quality of care being delivered to residents. As well as care workers, the home employs a home services manager, a handyman, a domestic supervisor, domestic and laundry assistants, cooks and kitchen assistants, and an activities organiser. National Vocational Qualification training is progressing well. In spite of the turnover of staff, the home currently has 57 of its care staff with the level 2 award in care, which is above the 50 expected in care homes for older people by the National Minimum Standards. The files for three people being recruited were looked at to determine whether the recruitment process was thorough. The records for each person included an application form, the question and answer sheet from the interview, reference material, and evidence to show that checks are being made with the protection of vulnerable adults list and the Criminal Records Bureau. The Manager will not allow anyone to start work until all the checks are complete. It is the Manager’s view that she must recruit the best person for the job, regardless of their colour, age, gender, etc. Potential recruits are taken on a tour of the home and introduced to residents, from whom the Manager receives feedback, and which contributes to the decision-making process. She said she looks for values such as compassion and understanding. She said that a background in care does not necessarily mean the person is a good carer. She believes that people with sound values can be trained to be good care workers. The records show that the majority of staff who work at Lyndhurst are female. This does not reflect the make-up of the residents living at the home, a good number of whom are male, and consideration should be given to improving the male/female make-up of the staff group when recruiting. Each new recruit is required to complete an induction programme, which introduces them to the routines of the home and to the correct procedures to Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 21 use when delivering care. During this period of time, the new recruit is supernummary to the rota and does not work unsupervised. The training and development programme is produced based on meeting the needs of residents. For example, as well as mandatory courses such as food hygiene, infection control, and moving and handling, staff attend training sessions that relate to dementia care and wound care management (known as “pressure damage”). The Manager said that the dementia care training was valuable because it taught staff to consider each person’s needs on an individual basis, and to determine how best to give that person a good quality of life. She said these principles can be applied to all residents, whether or not they have a cognitive impairment. Her view is supported by the entries in care plans which take account of the person’s ill- and well-being. There was good evidence of succession planning. One care assistant said she was about to begin training to become a senior carer; another was training to take on the role of Care Team Leader. Additional training is taking place on 13th July that relates to care planning because two new Care Team Leaders are joining the staff team. The Manager said she would use this opportunity to reinforce good practice to existing Care Team Leaders. At the care assistants meeting, those who attended did not need to be encouraged to put their names down for upcoming courses: they had already chosen which days to attend. Five comment cards were received by CSCI from relatives. Four people said that, in their opinion, there were always sufficient numbers of staff on duty, but one person disagreed with this opinion. One person described staff as “very helpful”. Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, and 38 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. The home is managed by a competent person, who makes sure that residents’ needs and preferences are the focus of the service that is delivered. The systems for managing residents’ personal funds are robust. Residents and staff are kept safe by the home’s policies are procedures, which ensure safe working practices. EVIDENCE: The Manager has demonstrated over the period of time that she has been in post that she is competent to run and manage the home. She has the NVQ level 4 in care and has a management qualification. She has attended periodic training sessions to keep her skills and knowledge up to date, the most recent being a Time Management course on 25th June 2006, the learning from which Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 23 she was putting into practice during this site visit. Recent changes to staffing and the transfer of residents, staff and household items from another CLS that closed, have presented challenges and frustrations for the Manager which have lead her to make decisions that she said have made her unpopular with some members of staff. It is the Manager’s view, however, that it is the best interests of the residents that come first, above her popularity. No bad feeling was in evidence at the time of this site visit. Staff were speaking openly with the Manager, asking for her opinion, and expressing their views without inhibition. For example, at the care assistants’ meeting, staff asked for the Manager to arrange something and told her she had agreed to do it following the last meeting, but hadn’t. One resident told the inspector that the Manager is “always working; always busy”, and that she “helps out a lot”. The home’s quality of service is measured in a number of ways. Periodically, residents and their supporters are canvassed about their opinions of the home, the results of which are compiled and reported back at the residents and relatives’ meeting. An evaluation of the service is carried out by an external company (RDB) who, this year awarded Lyndhurst with 5 Stars. The management of the home follows a set of internal audit procedures, for example, relating to care plans, and staff training and development. Audits are carried out on an at least monthly basis by a representative from the CLS Head Office (known as a Regulation 26 visit), the results of which are written into a report. A copy of this report sent to CSCI for information. The last Regulation 26 Report received by CSCI and dated 23rd May 2006 highlighted areas for improvement relating to accidents and care planning, medication audit, maintenance and repairs to the home (internal and external), fire drills, and staff supervision and appraisal. This shows that CLS is monitoring the quality of the service being delivered at Lyndhurst and identifying where improvements need to be made, to make the service better for residents. A copy of the home’s annual development plan is kept at the main reception so that visitors to the home can see what improvements are planned for the coming year. There are good systems in place to ensure that residents’ financial interests are safeguarded. Money that is kept at the home on behalf of residents is recorded, as are all the transactions that are made by the resident. The personal monies kept for three residents were checked and found to be in order. The Home Services Manager said that some residents look after their own money, or hand over this responsibility to their families. There was evidence to show that where residents’ capacity to manage their own money diminishes, the home has contacted an advocate to make arrangements for an independent person to be appointed. There was good evidence seen during this site visit to show that staff were aware of the way they must work in order to keep themselves and the Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 24 residents safe. At the care assistants’ meeting, staff gave good examples of safe working to prevent the spread of infection. Staff were seen to be utilising moving and handling equipment, such as hoists, and gave residents good instruction so that they used zimmers and wheelchairs safely. An incident occurred during this site visit in that the servicing of the lift caused a minor problem. During servicing, a fault occurred and put the lift out of service for 20 minutes towards the end of breakfast time. Warning notices were put on each lift entrance, and all staff, including the Home Services Manager, worked together so that residents still in their rooms on the upper floors received covered meals on trays. None of the residents said they were inconvenienced too much. The home does not have a dishwasher and one of the kitchen assistants spoke about the need to make sure cutlery and crockery were washed thoroughly before they are put into the sanitizing machine. If they were not clean when put into the sanitizer, any residual food or tea-stains become baked on, which then makes cutlery and crockery less suitable for residents to use. Accidents, injuries and incidents had been recorded and reported. The home had reported to CSCI several incidents where resident’ money had gone missing, and there were concerns about the security of the premises. The local police had been involved and had met with the residents. The majority of the missing money had subsequently been found, and much of it was in the residents’ rooms, for example having been put away in a place different from normal. There was no evidence to suggest that money had been taken by anyone from in the home. As a result of discussions with staff, families and residents, the police suggested that visitors to the home only be given the code to get out - but not to get in. This means that visitors to the home must request entry but are able to leave as and when they wish. This is extra work for staff who now have to answer the door to the many callers, but is a good compromise in order to ensure the premises are secure. Lyndhurst DS0000005747.V295432.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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 26 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 2 3 Standard OP7 OP7 OP23 Regulation 15 15 23 Requirement Entries in care plans must be dated. Action identified in care plans must be followed up. Dirty, worn and stained furniture, such as easy chairs and tables, must be removed and replaced. Timescale for action 31/07/06 31/07/06 31/07/06 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 OP7 OP7 OP23 Good Practice Recommendations It would be better if care plan reviews were written as if told by the resident. It is good practice to ask residents or their supporters to sign care plans to confirm their agreement. When the plans are being devised for improvements to the garden, consideration should be given to accessibility for residents, particularly those who use mobility aids independently or rely on others when moving around. Additional staff should continue to be provided if the dependency levels of residents changes, for example, overnight or at peak periods during the day. DS0000005747.V295432.R01.S.doc Version 5.2 Page 27 4 OP27 Lyndhurst 5 OP29 Consideration should be given to developing a staff team that reflects the make-up of the residents living at the home, for example, male/female ratio. Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 Lyndhurst DS0000005747.V295432.R01.S.doc Version 5.2 Page 29 - 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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