Inspection on 17/10/06 for Lyndhurst Care

This inspection was carried out on 17th October 2006.

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

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

Other inspections for this house

Lyndhurst Care 15/12/05

Lyndhurst Care 10/07/05

Lyndhurst Care 02/11/04

Lyndhurst Care 10/05/04

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 Care 120 Manchester Old Road Middleton Manchester Greater Manchester M24 4DY Lead Inspector Jenny Andrew Unannounced Inspection 17th October 2006 08.00 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 Care DS0000025481.V312110.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 Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lyndhurst Care Address 120 Manchester Old Road Middleton Manchester Greater Manchester M24 4DY 0161 643 9222 0161 653 8060 enquiries@lyndhurstcare.co.uk 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) Lyndhurst Care Limited Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Within the maximum registered number 33 there can be up to :33 Older People (OP) The service should at all times employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection. 15th December 2005 Date of last inspection Brief Description of the Service: Lyndhurst Care provides care and accommodation for 33 older persons. The home is situated near to the centre of Middleton, and is close to shops, the bus terminus, pubs and leisure facilities. The home was opened in 1986 and has been extended to include purpose built rooms to the rear of the house. The home is two storey and has the provision of a passenger lift. Accommodation is provided in 29 single rooms and 2 double bedrooms. Eleven of the bedrooms have the provision of en-suite toilet facilities. Three lounge areas (including a designated smoking area) are provided, plus a separate dining room. The home is well maintained both internally and externally. The gardens are attractively landscaped and accessible to service users. Ramped access is provided to one of the patio doors. Car parking is available to the rear and side of the home. At the time of this inspection, the weekly fees range from £331.42 - £340, dependent upon whether or not en-suite facilities are required. The home does not charge privately funding residents any more than those funded by the Local Authority. Additional charges are made for private chiropody and hairdressing. The provider makes information about the service available in the form of “Welcome” packs, which contained useful information about the home. A copy of the most recent Commission for Social Care (CSCI) inspection report is contained in the “Welcome to Lyndhurst” pack, which is displayed in the entrance hall. Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one full day with one Inspector. The inspector looked around parts of the building, checked the records kept on residents to make sure staff were looking after them properly (care plans) and other records the home needed to keep to make sure the home was safe for those living there. In order to obtain as much information as possible about how well the home looked after the residents, the owner, manager, 7 residents, 3 care assistants, the cook, laundry assistant, the activities co-ordinator, 2 relatives and the District Nurse were spoken with. In addition comment cards were sent out before the inspection to relatives, residents and professional visitors to the home. Of these 6 resident (2 completed by relatives on their behalf), 1 care manager and 6 relative questionnaires were returned. Other information, which had been received about the service, over the last few months, has also been used as evidence in the report. What the service does well: The home owner was constantly looking at ways the home could improve the quality of life for the residents living there. As he spent time there on a daily basis, he knew the residents well and by chatting to them he was able to find out whether they were happy with the care and service they were getting. When residents told him of any concerns or offered ideas to improve on the care offered, he would talk to the manager and look at ways of providing what they asked for. Residents felt they were well looked after by the staff and the following comments were made: “Staff are really good to me”, “couldn’t get better care anywhere”, “the staff are great”, “smashing”, “treat me with respect”, “staff will do what you ask them”, “both day and night staff are good”, “they come quickly when I pull my alarm bell” and “staff seem to work well together”. Throughout the inspection, the staff were seen to care for the residents in a kind, caring and sensitive way. The manager made sure the home only cared for those people whose needs the staff could meet. The home kept good records of peoples needs and the care they gave to meet those meets. Staff contacted doctors, district nurses and other health carers when residents needed them. The residents spoken to were all pleased with the meals they received with choices being offered at each mealtime. They commented; “you always get a choice”, “you can have anything you want at breakfast”, “it’s good home cooking”, “the food is very nice”, “if you don’t like what’s on the menu the cook Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 6 will give you something else” and “we have good cooks here”. Those people who needed special diets were well catered for and the staff had had training from a dietician so that they could make sure that the frail residents were getting the right food so they would not lose weight. The home was careful about whom they offered a job to and made sure they checked people out before they started work at the home. As many of the staff had worked at the home for many years, they had built up trusting relationships with the residents and knew their likes, dislikes and daily routines. The building was clean, hygienic and kept in excellent order throughout and the residents spoken with all felt the home was a comfortable and pleasant place to live. The manager met regularly with the staff both in team and one to one meetings so that the staff were clear about what they were doing well and what needed to be improved upon. Management meetings with the owner were also held. The owner was good at checking out the quality of care given. To do this, he asked residents, relatives/visitors and staff about their opinions and took steps to put what they said into practice. He also kept himself up to date with changes he needed to make such as updating residents’ contracts, which he had done very recently as required by the Commission for Social Care Inspection. What has improved since the last inspection? What they could do better: Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 7 When giving out the medication, the trolley should not be left unattended as this practice could place residents at risk. 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 Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The admission process was good with relevant information being given to residents before they moved in and an assessment taking place to ensure the home could meet their identified needs. EVIDENCE: Since the last inspection, the owner had been looking at ways of making the Service User Guide more interesting and easier to read for prospective residents. This was still in the process of being finalised and discussion took place of the need to ensure that within the changes, the information required to be given to new and potential residents was still contained in the document. He had also formulated a “Welcome to Lyndhurst” information pack which was in large print and put into the rooms of each new person coming to live there. It was clear that the owner was committed to ensuring that new and potential residents received as much information as possible in order to assist them in making their choice as to whether the home would be able to meet their needs. One of the newer residents said “staff and residents made me welcome Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 10 and I’ve settled in well”. Another resident, who had been coming into the home for respite stays, had now decided to stay on a permanent basis and she confirmed she had been given a copy of the home’s guide. Comments from a relative questionnaire included “I chose this home as my relative had been in before and been well cared for. I think Lyndhurst is a very well run home and have had connections with it for many years”. Another relative who was spoken to said he had been to look at several homes before deciding on Lyndhurst and he had chosen the home because it was clean, had no unpleasant smells and was well maintained. Following new legislation, the owner had also reviewed resident contracts to make sure they contained all the required information. Since they had been reviewed, residents and/or their relatives had been asked to read and sign the new contracts. Only approximately 5 or 6 still needed to be signed by relatives, when they next visited the home. The owner’s speedy response to the changes in what needed to be in contracts is commended. Four files were inspected and each contained an assessment, done by the manager before the resident moved into the home. She visited potential residents wherever they were living at the time, or when they visited the home to look around. The only exception to this was when residents were referred for a respite stay. Care managers were involved in arranging respite stays and the file of a respite client was seen to contain a detailed care management assessment. Feedback from residents and relatives indicated they were appropriately involved in the assessment process and considered the home was able to meet their needs. Information from the assessment documents had, where relevant, been included in the residents care plans. As the home had several mentally frail residents living there, the manager and several staff had undertaken dementia care training, in order to understand more fully how to meet these peoples needs. In addition a further 8 staff had been booked on the course between November 2006 and February 2007. Feedback from one relative questionnaire commented they felt that staff needed more training in how to look after people with dementia and this perceived shortfall will have been addressed when the remaining staff have completed the course. Other needs related training which staff had undertaken this year was nutrition – 9 staff, diabetes – 2 staff, managing and preventing aggression – 2 staff. In addition, 2 carers had undertaken a 4 week continence course. Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Residents’ health and personal care needs were being well met but improvements were needed in the dispensing of medication, to ensure the safety of residents. EVIDENCE: Three individual plans of care were inspected, two for residents who had been recently admitted. Since the last inspection, new care plan booklets had been introduced which enabled staff to include all relevant information about each person, including social histories. All 3 were detailed and had the information that staff needed in order to provide the right care and support to each person. Residents’ religious or special cultural needs were recorded on the care plan. The care plans were drawn up in consultation with the resident and/or relative and two of the plans had been signed. The other plan was awaiting the relative visiting so they could read through it and sign on behalf of the resident. Care plans were reviewed and updated on a monthly basis with full involvement of the resident and/or their representative. It was noted that where staff had identified changes when reviewing their residents, such Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 12 changes were not always transferred to the individuals care plan. Two such instances were highlighted to the manager who said the changes had only very recently occurred and that she would ensure the staff made the necessary amendments to the care plan. Records were also maintained about what care each person had received throughout the day and whether any problems had been identified. In addition, records relating to bathing and weight were in place and all were up to date. Residents spoken to all said they received sufficient baths and at the time of day they preferred to take their bath. One resident commented that she really enjoyed her evening bath so that she could go straight to her room afterwards and relax. Another person preferred to have a shower in a morning and this had been arranged. She commented upon how much she was enjoying the new shower facility. The staff said they tried to accommodate residents’ preferences in respect of what time of day they liked to bath or shower. At one care plan review, it was recorded the resident had requested to change her shower to a different time. This had been acted upon to her satisfaction. A key worker system was in place and several of the residents spoken to knew whom their worker was. Some with short-term memory loss were not able to name their worker but spoke positively about the staff team overall. The workers were given time, on a weekly basis, to undertake their key working duties and they felt this worked well. Key workers were also responsible for consulting relatives should this be needed. Feedback from relative questionnaires indicated they felt they were kept informed of important matters affecting their relatives/friends. One person felt they were usually consulted. The morning handover was observed and staff coming on duty checked a work rota to see what their specific duties would be on their shift. This ensured that all the staff were clear who was responsible for what task and ensured that residents’ needs for the day were fully met. All the residents spoken to felt their health care needs were being well met. Feedback from relative questionnaires mainly confirmed their satisfaction with this aspect of care, 5 stating they were kept informed of important matters affecting the person they visited. One person felt the home could improve slightly on this, by keeping her updated of all Doctors visits made to her relative. Another questionnaire commented that when her relative had to go to hospital no staff were available to take him and that the family had to make the necessary arrangements. The manager said that families were always asked whether they wanted the home to provide an escort or whether the family would prefer to attend. One of the relatives spoken to during the inspection commented that when the person they visited had to go to the Accident Department, the home had phoned to advise him and asked whether he wanted them to accompany her or if he wished to attend. He had been Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 13 pleased about their offer to attend due to work commitments. On the day of inspection, a care assistant had accompanied a resident to a clinic appointment. Food/fluid/turn/stand charts were put into place for residents who were being cared for in bed or for those assessed at risk and these were seen at the time of the visit. Staff were also vigilant with regard to ensuring that residents’ received sufficient to drink. Jugs of orange juice were displayed in the lounges and where residents had requested other drinks i.e. tonic water, this had been supplied. An example of good practice was seen in one of the lounges where a resident had fallen asleep whilst having a drink. The carer gently awakened her and encouraged her to finish her drink. Residents had regular access to chiropodists, opticians and district nurses. Referrals through G.P’s were made where staff identified problems in other areas such as dietician, physiotherapy etc. Visits by health care professionals were recorded on the individual resident’s care plan. The residents spoken with said the home would always send for their doctor if they were feeling unwell. The visiting district nurse commented that staff co-operated fully with any instructions given, that they had a pleasant attitude and that the residents always looked well cared for. She also commented that the home was always clean and fresh. She also confirmed that whenever she asked for pressure relieving aids, they were always provided. The manager and 7 of the staff had recently done training with the dietician on how to use the MUST tool (Malnutrition Universal Screening Tool). This was an assessment document that alerted staff to take action if a resident was assessed as being at risk of malnutrition. Following the training, each resident had been assessed, and dependent upon the outcome, risk assessment action plans showing low/medium or high risk had been implemented. The home was awaiting a visit from the dietician for a resident who had very recently moved into the home, who had been assessed at high risk. Whilst the home had continued to give nutritional supplements, prescribed by the doctor and occasional milk shakes, they had not recorded what other high calorie snacks were being given to try and increase her weight. In line with the risk assessment action plan, this should be addressed. All 3 files contained assessments relating to daily living, moving/handling, mental health, Waterlows (skin), nutrition and falls. Where other risks had been identified, assessments were in place for example self-medication and beds being fitted with safety sides. Risk assessments were reviewed on a regular basis. Where it was identified there was high risk, action plans had been formulated showing how the risk was to be managed in order to lessen it. Systems in place for the administration of medication were in need of improving in order to ensure residents’ safety. From observing the morning medication round, the senior carer was seen to administer the medication Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 14 efficiently, signing the Medication Administration Records (MAR) after giving out each person’s medication . However, the practice of leaving the drug trolley unattended, with drugs being left out of the trolley, was noted. The trolley was in the smoking lounge, which at the time, 2 residents were using. The manager said it would take too long for the senior to lock and unlock the trolley each time she went to give out the medication and that usually no residents used the lounge at the time of the medication round. In order to ensure the safety of residents’ a different system must be introduced and a suggestion was made for two staff to undertake this task, one remaining with the trolley whilst another person dispensed the drugs. The medication policy included self-medication but it was unusual for residents to hold anything other than inhalers or creams. Where self medication was taking place, risk assessments would be completed and all bedrooms were equipped with lockable storage space. Unused medication was regularly returned to the pharmacy and the home was not holding large stocks of medicines. The last returns had been collected on 4 October, 2006 but the representative had not signed the returns sheet. All other sheets had been appropriately signed. The manager was to address this. Controlled drugs were being dispensed and stored safely and in accordance with the home’s policy. Those checked were seen to be in order. All staff, responsible for giving out medication, had received appropriate training. The aims and objectives of the home reinforced the importance of treating residents with respect and dignity. Residents interviewed were all complimentary about how staff assisted them with personal care tasks and felt their privacy and dignity was respected at all times. Relatives confirmed they were satisfied with the staff’s manner and attitude towards the people they visited. The care assistants interviewed were able to give good examples of how they promoted privacy and dignity in their daily care routines. These included using the right approach and giving gentle encouragement, explaining to people what you are going to do and why so they didn’t become angry and frustrated, encouraging people to be as independent as possible especially when bathing and knocking on doors before entering. One resident commented “I always receive my post as soon as it arrives” and also confirmed it was always unopened. The new walk in shower was well equipped with a shower screen and shower curtains. During the inspection observations indicated staff were sensitive and caring in their attitude towards the residents. One returned questionnaire, completed on behalf of a resident, indicated that staff were sometimes slows to respond to call bells. Residents spoken with on inspection said usually staff responded quickly but on occasion they may have to wait for them to finish helping another person. One resident made particular reference to the night staff stating, “night staff are really good, I just press my buzzer and they’re there). Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is excellent. This judgment has been made using available evidence including a visit to this service. Residents were able to follow their chosen lifestyles both in and outside of the home and varied and nutritious meals were provided for them. EVIDENCE: Residents were able to make choices in many areas of their daily routines but this did depend on their mental frailty. Residents spoken to gave examples of choices they regularly made: where to sit (there being 3 lounges), what to wear, whether to join in with activities or not, when to get up and go to bed, what to eat and where to see their visitors. When residents first came into the home, a brief social history was recorded, involving the resident and/or their relative so that the home would have some information about what kind of things the person had previously enjoyed taking part in and what sort of routine they preferred. Whilst social activities had been assessed at the last inspection as being good, they had been further improved by the recruitment of a part-time activity coordinator. The owner had received some comments from returned quality questionnaires, that on occasions, residents felt they needed more to keep them occupied. He had therefore acted on the feedback and recruited an Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 16 activity co-ordinator specifically to undertake this work. She worked three days a week from 10.00 – 16.00 and in addition an outside craft worker visited once a week. The co-ordinator said she worked flexibly to meet the needs of the residents and would do some of her hours at weekends or evenings if needed. Each person had an activity profile in place, identifying the person’s interests and a record showing what activities they had taken part in. When residents had declined to join in this was also recorded. From speaking to residents, checking monthly activity programmes and entries recorded in the activities book, it was evident that the needs of both individuals and groups were being well met. Comments received from residents included “we have allsorts going on”, “I really enjoyed the outing to see the children maypole dancing”, “enjoy the monthly trips out for a meal”, “enjoy the organist” and “really good entertainers visit”. One resident made reference to staff taking her out regularly into Middleton to do some shopping and other entries recorded showed this had been a regular feature over the summer months. The activities undertaken by the co-ordinator were varied and included one to one time with the residents who preferred to stay in their rooms or not to join in organised activities. In-house activities included bingo, nail care, arts/crafts, quizzes, reminiscence, sing songs and memory games but resident feedback was sought and any suggestions were put into place. Monthly programmes were displayed showing the forthcoming events/entertainment and trips out to places of interest or to pubs/restaurants for meals. Photographs had been taken of such outings and it was evident the residents had really enjoyed these trips. On the morning of the inspection a group of residents were enjoying a game of dominoes with the activity co-ordinator. Later in the day, in a different lounge from the morning, a music quiz was being held. Old time music tracks were being played with residents singing along and then guessing the title of the song. It was evident the residents were really enjoying this activity and the atmosphere was lively and happy. The home used “Ring and Ride” transport, which enabled the residents who were reliant upon wheelchairs to be included in the outings. Entries in the visitors’ book identified that many relatives visited on a regular basis. No restrictions on visiting times were imposed. Relatives were invited to activities such as coffee mornings, outings and themed evenings such as the forthcoming bonfire night celebrations. Relative meetings were also held. Feedback from returned questionnaires indicated they were always made welcome by the staff and could always see their relative in the privacy of their bedrooms. Residents benefited from the regular trips out into the local community, which the home organised. In May a few residents had enjoyed a social dance Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 17 evening at one of the local churches. Also arrangements were made for children from the local schools to come in to entertain the residents. Several residents commented upon how much they enjoyed seeing the children. One recent event had involved a local children’s workshop coming in to provide entertainment and this had been really well received. Individual residents were encouraged to continue with past external interests or hobbies and two people were pursuing these on a weekly basis. Whilst residents were encouraged to manage their own financial affairs as far as they were able, it was generally their relatives who assisted with this. The home were however, aware of advocacy services should a resident need some impartial advice and support. Provision was made for residents to continue to follow their chosen religions, with regular attendance at the home by representatives from both Church of England and Roman Catholic faiths. Feedback from residents about food, both from questionnaires and from interviews, was positive about the quality, amount and choices offered. One questionnaire did however make comment that teatime menus were sometimes repetitive with soup and sandwiches being served too frequently. Whilst they were offered regularly, as many of the residents enjoyed a lighter meal, there was always a hot optional snack. Resident meetings were now being held monthly and from checking the minutes of the last two meetings, it was seen that food was always discussed. As a result of one suggestion made, salmon had been introduced to the menu. From checking the 4 weekly menus, it was identified that a good selection of food was offered at each meal time. The menu was displayed near the front door, so that visitors could also see what was being offered to the residents. Residents were particularly complimentary about breakfasts and lunches. They said they could have anything they liked for breakfast such as bacon and egg, scrambled or poached eggs, cereal, porridge, grapefruit and toast. All these were observed being served at breakfast. Two hot choices were served at lunchtime and desserts were served at both meals. In addition residents enjoyed suppers and said they could have cakes, biscuits or toast. Milky drinks were also offered. Residents also said if they didn’t like what was on the menu, they would be offered something else. On the day of the inspection, the lunch choices were, meat and potato pie or lamb casserole with carrots and swede and roasted potatoes followed by lemon sponge and custard. The inspector sampled both main meal options. The meat and potato pie was very tasty as was the casserole with the meat being extremely tender. The tea-time choices were burger in a bun or mushroom soup, followed by fruit and cream. Menus showed that a good assortment of vegetables and fruit were offered over the week and apples and bananas were available in the home for residents to help themselves to. Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 18 The individual dietary needs of residents were being well met and dietary and fluid charts were completed as and when needed. As previously stated all residents had been assessed using the Malnutrition Universal Screening Tool (MUST). The cook used sugar substitutes when cooking, so that any resident following a diabetic diet could enjoy many of the same foods as the other residents. The dining room was bright, well decorated and new non-slip flooring had recently been fitted. In addition, as part of the refurbishment programme, new tables and chairs had been bought. At both breakfast and lunch, there was a lively atmosphere with residents and staff chatting to each other. It was also seen that those residents who needed some assistance or prompting with their meals were sensitively assisted. Where residents took time to eat their meals, as was observed on the inspection, staff would re-heat it for them so they could continue to enjoy it. Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is excellent. This judgment has been made using available evidence including a visit to this service. An effective complaints system was in place which residents were familiar with and staff training and good recruitment practices ensured that residents were protected from abuse. EVIDENCE: A complaints procedure was in place which was included in the service user guide and statement of purpose. It was also displayed within the home. A complaints log book was in place and since the last inspection, 2 complaints had been logged. The owner and manager had taken appropriatre action to address the problems which had been raised. The outcome for the residents had been recorded and all parties had been kept advised. The Commission for Social Care Inspection had not had cause to investigate any complaints about the home over the last 12 months. There was a comments book kept and many thank you cards were seen to have been received. The residents spoken with all felt they could speak to the owner, manager or any of the staff about problems and that they would be listened to. In-house customer care training was given to all staff, which helped them in understanding that residents needs and wishes must always be prioritised. The provider and manager were good at addressing areas of concern that either residents or their relatives raised, before they became a complaint. In order to improve customer satisfaction, the owner was spending time with residents and/or their relatives when doing his monthly report for the Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 20 Commission for Social Care Inspection (CSCI). A returned questionnaire had identified several areas that a relative had been dissatisfied with. Upon the inspection, it was noted that the owner had already addressed the problems, as a result of spending time with this relative. Any areas for improvement noted on the home’s in-house quality assurance questionnaires, were also recorded and actioned. A procedure for responding to allegations of abuse was available as was the Rochdale Inter-Agency Protection of Vulnerable Adults (POVA) procedure. No protection investigations had taken place over the last year. Since the last inspection, a further 4 carers had attended Rochdale MBC POVA training course which meant that the majority of the staff team had done the training. In addition 10 staff had completed NVQ level 2 training (or above), which included a unit on elderly abuse. Staff files showed that Criminal Record Bureau and POVA first checks had been done before any new staff started work so as to ensure that the staff were suitable to work with vulnerable people. The staff spoken to were knowledgeable about what to do if they should have any suspicion that a resident was subject to any form of abuse. Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 21 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 & 26 Quality in this outcome area is excellent. This judgment has been made using available evidence including a visit to this service. The home was clean, safe and well maintained providing a comfortable and homely environment for the residents. EVIDENCE: The home owner had a maintenance programme in place, ensuring that the home was well maintained, as had been the case at previous inspections. The owner was committed to providing a safe, pleasant environment for the residents. As soon as any bedrooms became vacant, they were re-decorated and carpeted before a new resident was admitted. The only exceptions to this would be when the rooms had only very recently been re-furbished. All the residents spoken to were really pleased with their bedrooms. Due to problems with continence, one room had been fitted with good quality vinyl flooring, and before this had been done, the owner had spoken to both the resident and relative to make sure they were happy with the proposals. The majority of the Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 22 bedrooms were over the minimum size requirement and were personalised with the residents’ belongings. Since the last inspection, one of the bathrooms had been converted to a walk in shower unit, fitted with a privacy screen and curtain. This had been done so that residents could have a choice of a bath or a shower. The other bathroom had also been totally refurbished. Both rooms now provided clean, safe and hygienic bathing facilities and several residents commented that they were really enjoying having a shower rather than a bath. Other improvements consisted of another bedroom having been fitted with an en-suite toilet; new non-slip flooring fitted in the dining room; new dining tables/chairs and retiling of the kitchen. New carpeting in the lounges was due to be fitted the week following the inspection, although the existing carpets still looked clean and in good condition. Residents had a choice of 3 lounges, one of which was designated for smokers. The owner had recently made a decision to change the home to non smoking status. However, as a minority of residents had chosen Lyndhurst because smoking was permitted, the owner had publicised in the guide that existing residents only would be able to smoke in the future. A fire inspection had taken place in February of this year when the Greater Manchester Fire Authority had made several requirements. These had all been completed to the Fire Authority’s satisfaction. The owner had identified that several residents with poor mobility were struggling to walk with their aids and open the ground floor main heavy corridor doors, without the assistance of staff. In order to promote their independence, but at the same time complying with fire regulations, the owner had fitted a magnetic door release system which was activated should the fire alarm go off. This had been so successful with the residents that the owner had decided to implement this system throughout the rest of the building. This good practice is commended. Relatives and residents were very complimentary about the cleanliness within the home and said that the home did not have any malodours. A walk around the building supported this view and the home was spotlessly clean throughout. One visitor said the clean well kept building had influenced his choice when looking around the home initially. Since the last inspection additional cleaning hours had been allocated and another domestic employed. Level access to the gardens was provided from the smoking lounge. This enabled those people reliant on wheelchairs to have easy access. Residents said they could get around the home easily and appropriate aids and adaptations were fitted in bathrooms, toilets and corridors so that residents could remain as independent as possible. Everyone spoken with thought the home was a safe place to live and work in. Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 23 An infection control policy was in place and several of the staff had undertaken relevant training. A further 6 carers were booked on infection control training over the next 4 months and the manager was booked on a management infection control training course. The staff interviewed described safe infection control practice. Disposable gloves and coloured aprons were provided for staff use and to reduce the spread of infection, liquid soap and paper towels were supplied in all bedrooms, bathrooms and toilets. The laundry was sited away from the food preparation area and was clean, well decorated and orderly. Sufficient and suitable equipment was provided and the washers were equipped with sluicing facilities. The laundry assistant was spoken with and she confirmed that at the time of the inspection, there were no garments waiting to be returned to residents as a result of them being unmarked. One resident said she liked the laundry basket in her bedroom as she knew her clothes would be taken each day to be washed and ironed, which she said the staff did well. Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 24 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 & 30 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Sufficient numbers of staff, with an appropriate skill mix were provided who did not start work until all references and checks had been undertaken, ensuring they were suitable to work with the residents. EVIDENCE: Inspection of rotas showed that staffing levels were adequate to meet the needs of the current resident group. Feedback from 2 relative questionnaires did however comment that they felt staffing levels needed to be higher. In order to check out this comment, residents and staff were asked about staffing levels. Residents said the staff were attentive and spent time with them, when they were not looking after other residents. All were satisfied with the care they were receiving. Staff felt they were able to do their jobs adequately with present staffing levels. The provision of ancillary staff was good with a cook, housekeeping supervisor, kitchen assistants, laundry and domestic staff being employed. Since the last inspection there had been some changes in the staff team. However, many of the staff had worked at the home for several years, some having been there since it opened. This relatively low staff turnover, meant that the residents had built up good relationships with the staff whom they trusted. The staff team was all white British, but this reflected the current service user group. Five male residents were living at the home and 1 day and 2 night Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 25 male care assistants were employed. This meant that male residents did have some choice in who assisted them with personal care tasks. One male carer who was spoken to demonstrated his awareness of checking with female residents, whether they were happy for him to assist them. He identified one person who did not want a male carer and this had been recorded. He said he always respected the wishes of the residents. Feedback from the residents was very positive about the staff team and manager. From observations made during the report, it was evident that good relationships had been made between staff who were polite and respectful towards them. Staff feedback indicated staff morale was high, resulting in good team work by an enthusiastic workforce that worked positively with residents to improve their quality of life. The manager made sure that staff had the necessary information to undertake their roles efficiently and effectively. Good communication systems were in place e.g. staff handovers, communication book, work rotas and diaries. The owner was committed to offering training opportunities to the staff. One of the conditions of employment was that staff would be willing to attend training courses requested of them. Of the 21 care staff currently employed 10 had successfully completed NVQ level 2 training or above and 1 had almost completed the training. This meant the home would achieve at least 50 of trained staff before the end of the year. In addition a further 3 carers had just started to do the training. The manager was now being more selective when recruiting staff and had recently recruited 1 new carer with an NVQ 2 qualification. Opportunities were also available for staff to advance their training further. One carer had achieved both NVQ levels 3 & 4, 2 had completed NVQ level 3 training. Inspection of records showed that safe recruitment and selection practices were followed in line with the home’s procedure. These included receipt of 2 satisfactory references, Protection of Vulnerable Adults (POVA) and Criminal Record Bureau (CRB) checks. Staff were also given copies of the General Social Care Council “Codes of Practice” upon appointment. The manager said that when staff left without notice, they sometimes had to appoint staff before the full CRB check had been returned, but that a POVA first check would always be done. Such staff worked under close supervision until the CRB arrived. The Manager should be mindful that guidance from the Commission is that generally staff should not start until the full CRB has arrived at the home. When new staff started work, they did induction training in order to learn how to do their jobs safely. One staff file showed the worker had attended an external Skills for Care training induction day. Since that, the carer had been on relevant health and safety training courses and was booked on others. Two Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 26 staff files contained evidence that induction training was undertaken over several weeks and whilst it was not Skills for Care unit based training, it covered relevant topics. Evidence to show how the various areas had been assessed was not however, recorded and only the supervisor and supervisee’s signatures were. Discussion took place about the need to record more detail to show how the supervisee had been assessed as competent. In order to ensure that all Skills for Care training units were adequately addressed, it is recommended that their format be used. When using this format, where staff have successfully completed NVQ level 2 training, it should be cross referenced within the training records. Sections specific to the home should be fully completed i.e. policies/procedures, aims/objectives and care practices. The manager said she would address this in future induction training. The provider and manager were vigilant in ensuring that staff attended all the required health and safety training. Refresher training was also arranged as and when necessary. One training shortfall was identified with regard to equality and diversity and the manager should make this her next training priority. Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 27 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, 36 & 38 Quality in this outcome area is excellent. This judgment has been made using available evidence including a visit to this service. An effective management team were in place ensuring that residents received a consistently high standard of care. EVIDENCE: The owner of the home was very involved in the business, giving excellent support to the manager. His regular, usually daily presence at the home enabled him to immediately identify any health and safety matters and to update and replace equipment, fittings and furniture as and when required. He was familiar with the residents and had regular contact with their families, especially with regard to checking out their satisfaction with the service. The manager had been running the home since it first opened in 1986 but before this, had trained as a nurse. She was therefore knowledgeable about Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 28 the conditions and diseases associated with older age. She had completed her NVQ level 4 in care and in September 2004 successfully completed the Registered Managers Award. She was mindful of the need to keep up to date with training and so far this year had been on courses in relation to stress management, nutrition (MUST), fire safety and customer care. The week following the inspection, she was booked on an infection control management course. It was evident from records seen and from speaking to staff that both the manager and owner were extremely vigilant about monitoring care practices within the home. The manager worked some hours on the floor, which enabled her to observe the way the staff cared for and spoke to the residents. The owner also chatted to residents and relatives to check they were satisfied with the service being offered. Any weaknesses identified from any source were immediately addressed. Feedback from the home’s internal quality monitoring system indicated relatives/residents had scored the manager excellent or good with regard to being readily available and willing to discuss enquiries/problems with them. Feedback from the staff about the manager was positive with comments made such as “fair”, “approachable” and “offers support when needed”. The staff interviewed said they received regular one to one sessions, which they valued and supervision records confirmed that these were usually done every 2 months. Annual appraisals were also undertaken and at the time of the inspection, 16 had taken place. The manager was on track to complete the remainder by the end of December 2006. As well as achieving The Investors In People Award, the systems for resident consultation in this home were good with a variety of evidence seen, which indicated that residents’ views were both sought and acted upon. As stated previously, the owner did a monthly report about resident/relative satisfaction, by chatting to people and recording their responses. In instances where people were dissatisfied, swift action was taken to address problems, which meant the home had a very low complaints record. A six monthly “How Are We Doing” quality assurance survey was carried out involving residents and relatives/friends. The evidence was obtained through the circulation of questionnaires, and responses up to 14 September 2006 had been collated. The overall outcome was that over 96 of questionnaires identified satisfaction levels as either excellent or good. A supply of the responses was displayed in the entrance hall for relatives to take and residents had been given copies. The provider or manager took appropriate steps to address any constructive criticism as far as possible. In addition to questionnaires, a quarterly newsletter was published in large print, which asked for any comments about the care and facilities provided at the home. Residents meetings were also now being held on a regular monthly basis. Minutes seen showed that many topics were discussed, the main ones being activities, trips Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 29 out and food. Suggestions made were implemented as far as possible. One resident had requested salmon be put on the menu and this had been done. The owner had drawn up a business plan for 2006-2007 to review previous objectives and identify continuing initiatives. Previous objectives achieved included staff training, quality assurance and monitoring and building maintenance. Staff meetings were held for different groups e.g. senior carers, night and day staff and management. Discussion took place about holding more regular full staff meetings and the manager said she would consider this. Policies and procedures were regularly reviewed in the light of changing legislation and the home worked co-operatively with the CSCI to implement any identified shortfalls. Any requirements made in reports were always addressed within the given timescales. The majority of the residents living at Lyndhurst, relied upon their relatives to handle their financial affairs. Some relatives left money at the home for staff to give to individual residents as they needed it and receipts were in place where staff had purchased items on their behalf. Hairdressing and chiropody accounts were also in place. Personal monies for 3 residents were checked and found to be in order. The pre-inspection questionnaire recorded that all required health and safety policies and procedures were in place. In addition, the owner and manager were vigilant in ensuring that staff received their health and safety training with refresher courses being arranged as needed. Staff training over the last 12 months was impressive. Information from the pre-inspection questionnaire showed that since January 2006, 2 staff had undertaken medicine management training, 10 completed moving/handling, 13 first aid, 12 fire and first aid and 5 food hygiene. In addition fire training for those who had not previously attended had been booked in November. Future training already booked included 6 on infection control and 10 on Control of Substances hazardous to health (COSHH). Sampling of 3 staff files and speaking to staff, confirmed that refresher training was undertaken as needed. Training certificates were in place in the files inspected. The fire training, done in-house by an external trainer, had been tailored specifically for the building. This ensured that the staff knew exactly how to respond in the event of a fire. The pre-inspection questionnaire identified that maintenance checks were up to date. Random record sampling was undertaken of the public liability certificate, servicing of lifts/hoists and fire equipment. The servicing of the hoists should have been done the week before the inspection as the home had a contract with the company concerned. They had cancelled the visit but a Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 30 telephone call to the company confirmed they had changed the date to 18 October 2006. Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 31 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 3 4 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 x 18 4 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 3 X 4 Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 Requirement The registered person must ensure the safekeeping of medication by keeping the drug trolley locked or under constant supervision when dispensing medication to ensure the safety of residents. Timescale for action 27/10/06 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. Refer to Standard OP7 OP30 Good Practice Recommendations At monthly reviews, where staff identify changes in a residents care, such changes should be recorded in the relevant section of the care plan. The manager should use the Skills for Care Induction format for all new staff, ensuring that previous training is cross-referenced to the relevant units. Lyndhurst Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 33 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 Care DS0000025481.V312110.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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