CARE HOMES FOR OLDER PEOPLE
Lyndhurst Nursing Home 238 Upton Road South Bexley Kent DA5 1QS Lead Inspector
Maria Kinson Unannounced Inspection 16th December 2005 11.35 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 Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 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 Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Lyndhurst Nursing Home Address 238 Upton Road South Bexley Kent DA5 1QS 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) 01322 523821 01322 523821 Mr Richard Mahomed Mrs Rookaya Mahomed Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Lyndhurst Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 16 beds Elderly and infirm Date of last inspection 18th October 2005 Brief Description of the Service: This home is located in a residential area of Bexley, within walking distance of local shops, a railway station and bus routes. There are five double, one triple and three single bedrooms in the home. Communal space consists of a lounge, which is also used as a dining area during mealtimes. At the rear of the property there is a spacious garden for residents use. Parking is restricted in the roads surrounding the home, limited off street parking is provided on the driveway. Lyndhurst Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on 16.12.05 between 11.35pm and 15.00pm and on 21.12.05 between 16.00pm and 18.50pm. Care, recruitment and health and safety records were examined. The inspector spoke with two relatives and two residents during the visit and obtained written feedback about the service from one relative and two social care professionals that were in regular contact with the home. One additional visit has taken place since the previous statutory inspection to monitor compliance with requirements and recommendations. The report from this visit can be obtained from the local CSCI office on request. What the service does well:
The management arrangements in this home were stable. The home has a reasonably stable team of nursing and care staff, who provide a consistent standard of care. Staff were approachable and friendly and communicated effectively with residents and relatives. 50 of care staff had attained a vocational qualification in care at level two or above. Feedback from residents, relatives and social care professionals was good. Residents and relatives expressed satisfaction with the standard of care provided and commented that staff were “gentle and approachable”. Relatives were satisfied with the visiting arrangements and said that trained staff took time to answer their questions. The manager obtained comprehensive information about prospective residents to ensure that staff could meet resident’s needs on admission to the home. Staff respected resident’s decisions not to participate in certain activities and maintained accurate and factual records when residents declined care or assistance. The home was well-maintained, clean, tidy and odour free. Equipment was serviced at regular intervals and fire safety arrangements were mostly satisfactory. The programme of activities and outings continues to develop under the guidance of the activities coordinator. A varied and interesting programme of events and activities were arranged for residents during the Christmas period. Lyndhurst Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 Page 6 The home has an easy to follow complaints procedure but had not received any complaints in the period since the last inspection. What has improved since the last inspection? What they could do better:
Five of the requirements that were set following previous inspections had not been met. A number of requirements have now been repeated several times. A meeting has been arranged with the registered person to discuss this and other issues. Three requirements relate to recruitment practices. Failure to follow robust procedures when recruiting new staff could place residents at risk of harm. Records indicated that new staff did not always receive induction training, did not receive adequate supervision and two written references were not always obtained. The standard of induction training provided for some members of staff did not meet nationally recognised standards. Staffing numbers did not always comply with the minimum staffing notice. This put unnecessary pressure on staff and could affect resident’s quality of life. The off duty rotas were difficult to interpret and were not kept up to date. One relative expressed concerns about staffing.
Lyndhurst Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 Page 7 The records maintained about resident’s personal money were inadequate. The current arrangements do not protect residents or staff. Health and safety arrangements were mostly satisfactory but staff were not undertaking a risk assessment prior to using bedrails. A procedure was being developed to address this issue. Fire safety records were good but staff must review the homes fire risk assessment and ensure that adequate records are maintained about staff response during fire drills. The care records did not always provide adequate information to enable staff to take appropriate action to meet resident’s needs. The Service Users Guide had been updated. The guide does not include all of the information listed in the national minimum standards for older people. There was little evidence to suggest that work had been undertaken to assess the quality of the service provided in the home. 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 Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 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 Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 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 and 3. The Service User Guide did not provide adequate information about the service for residents. The home had a satisfactory system in place for assessing the needs of residents who were funded by a local authority. Staff had access to information that enabled them to meet resident’s immediate needs on admission to the home. EVIDENCE: The manager had updated the Service User Guide in November 2005 to include all of the information listed in The Care Homes Regulations. The registered person had not included information listed in the National Minimum Standards for Older People, which is identified as best practice. See recommendation 1. The home received a copy of the Joint Assessment Panel papers when residents funded by the local authority were placed in the home. The
Lyndhurst Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 Page 10 information included in this document combined with the homes own assessment provides sufficient information for staff to meet resident’s needs. The manager should ensure that it is clear to the reader which information was obtained prior to admission. Lyndhurst Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 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. Some records did not provide adequate evidence of the action staff were taking to meet residents health and welfare needs. This could result in some residents receiving an inconsistent standard of care. EVIDENCE: Written feedback from two social care professionals that visited the home in recent months was good. The respondents said that staff had a good understanding of residents needs, kept them informed about significant events and were satisfied with the overall standard of care provided in the home. Two sets of care records were examined. Some improvements were noted. Both of the files included an assessment of the individual’s family and social background and a care plan that outlined how staff would meet their recreational and social needs. Staff must ensure that needs identified during assessments are developed into a plan of care. The records and assessments for one resident indicated a high risk of developing pressure sores, a poor appetite and significant weight loss. There were no care plans to guide staff
Lyndhurst Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 Page 12 about the actions they should take to avoid these risks and meet the residents needs. See requirement 1. The manager said that new assessment sheets, which will provide more detailed information about residents needs, had been developed and would be introduced soon. Lyndhurst Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 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 and 14. Residents were encouraged to take part in a stimulating and varied programme of activities. Residents were encouraged to make personal choices. Relatives were consulted about significant issues where this was not possible. Relatives were able to spend time and provide care for their family member in the home. All of these issues can improve resident’s sense of wellbeing. EVIDENCE: The programme of activities and outings arranged by the activities coordinator were continuing to develop. A number of events and outings to local schools, churches, garden centres, parks and shopping malls had been arranged and a Christmas party and entertainment were planned. Please see standard 27 re staffing. Relatives were satisfied with the overall standard of care provided in the home. Relatives said that staff were “gentle” when handling and assisting residents and addressed residents in a polite and courteous manner. Relatives also commented that trained staff were approachable and answered their questions promptly. Residents and relatives were satisfied with the visiting arrangements.
Lyndhurst Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 Page 14 It was difficult to assess resident choice during this inspection, as a number of residents were asleep or very frail. Records and conversations with staff did provide some evidence that residents were encouraged to make personal choices and their decisions were respected. The plan to fit a carpet in a resident’s room was abandoned during the inspection as the resident refused to move out of the room. Records indicted that one resident had refused to attend the Christmas party and care plans advised staff to promote resident choice by encouraging residents to choose their clothing. Lyndhurst Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 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. This home has a comprehensive complaints and adult protection procedure in place for responding to complaints or allegations of abuse. EVIDENCE: The home had not received any complaints in the period since the last inspection. The commission have not been made aware of any complaints or adult protection issues relating to this service. Lyndhurst Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 Page 16 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, 23 and 26. This home provides a clean and comfortable environment for residents. The Registered Provider has advised the commission that the bedroom occupied by three residents will be converted into a double room in December 2005. This will provide more privacy and dignity for the residents concerned. Kitchen staff did not always follow strategies to reduce the risk of food contamination. Failure to rectify this issue could place residents at risk of harm. EVIDENCE: The building was maintained to a high standard. The previous requirement to repair the loose handrail, toilet seat and window restrictor had been addressed. Staff had noted a leak in the ceiling in one of the resident’s bedrooms on day one of the inspection. Action had been taken to arrange for the homes repair man to assess the cause of the leak and carry out the necessary repairs. The leak was prepared prior to the inspector’s second visit. The home was clean, tidy and odour free.
Lyndhurst Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 Page 17 A new wall at the entrance to the property had been built and two bedroom carpets were due to be replaced. The manager said the arrangements for replacing the dining room carpet had been delayed until after the work to build the conservatory was complete. Three residents occupied one of the bedrooms on the first floor. The Registered Person advised the commission that this room would be converted into a double room by December 2005. This work had not been undertaken at the time of this inspection. The manager said that he would be writing to the commission about this issue. A local environmental health inspector had inspected the main kitchen in November 2005. A number of strategies listed in the homes hazard analysis were not being followed. These issues will be followed up by environmental health. Lyndhurst Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 Page 18 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. The arrangements for staffing the home during periods of staff sickness were inadequate and could compromise resident’s safety. The number of staff with a vocational qualification in care complies with best practice guidance. The arrangements for recruiting new staff did not provide adequate protection for residents. There was little evidence to suggest that staff received adequate training when commencing work in the home. This could result in residents receiving poor standards of care. EVIDENCE: There was one trained nurse and two care assistants on duty on day one of this inspection. This did not comply with the minimum staffing notice that was issued by the previous regulatory authority. The trained staff had contacted care staff that were off duty to see if they could cover the vacant shift but had not contacted any agencies. As a result of staff shortages staff were extremely busy and appeared stressed. The trained member of staff was attempting to deal with the leak in a residents bedroom, liaise with the carpet fitter, administer medication, prepare two residents for a Christmas shopping trip, speak to visitors, assist care staff with feeding during the lunch period, arrange an escort to accompany residents on a shopping trip and answer the inspectors questions. Three residents that would normally spend the morning in the lounge were kept in bed to reduce the workload for staff. Staff were asked to
Lyndhurst Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 Page 19 take shorter meal breaks to provide support for staff. The Registered Person must take prompt action to ensure that there is no regression to the staffing notice. The inspector examined the off duty roster for a three week period. The roster included codes for different shifts. The registered manager should include a list of codes on each off duty sheet. One member of staff that was sick was not marked as sick on the rota and one member of staff that the manager said had worked some additional shifts to cover sickness was not recorded as working in the home on this day. These issues made the rota difficult to interpret and follow and could cause further staff shortages. See requirement 2. All of the staff on duty communicated sensitively and effectively with residents and were cheerful and friendly. The manager told the inspector that four care assistants had attained a vocational qualification in care at level two or three. This complies with the target set by the Department of Health. Two staff recruitment files were examined. The files did not always include two written references, an interview record, a record of induction training or details of the arrangements for supervising new staff whilst criminal record bureau disclosures were pending. See requirements 3, 4 and 5 and recommendations 2 and 3. The manager advised the inspector that he was planning to install a recruitment software package on his computer. The homes induction procedure stated that staff would be helped to understand TOPSS standards during induction training. There was no evidence that this had taken place. Lyndhurst Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 Page 20 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. Adequate systems were not in place to protect resident’s money and to assess the quality of the service provided. Most health and safety issues were managed effectively but records were sometimes poorly organised and staff did not always consider potential risks to residents when applying bedrails. The manager must address these issues promptly to protect residents. EVIDENCE: The management arrangements were unchanged. The number of requirements that were not addressed by the Registered Person and have been repeated in this report is a concern. The commission has arranged to meet the provider to discuss this issue. The arrangements for assessing the quality of the care and services provided in the home were poor. A medication audit was carried out in October 2005.
Lyndhurst Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 Page 21 There was no evidence that any other audits or satisfaction surveys had been undertaken. See recommendation 4. Personal money records were poor. Individual records were maintained for each resident and were kept in a book in the office. For some transactions there were no signatures to confirm who had received money deposited in the home or who had withdrawn funds from their account. This provides little protection for residents or staff. The inspector viewed two resident’s money records on day one of the inspection and checked the balances on day two. Money appeared to be used appropriately and receipts were retained for hairdressing or other services. The manager was the only person who had access to residents funds other than money handed to staff for safekeeping when the manager was not on duty. Two residents were due to go Christmas shopping on day one of the inspection. The nurse in charge used her own money for transport costs. One resident did not have any spending money. The manager said that money to cover expenses had been left for staff. See requirement 6. Fire safety equipment was serviced at regular intervals and most of the in house fire safety checks were satisfactory. Staff should ensure that a summary of how staff respond to fire drills is recorded. A fire risk assessment had been undertaken in 2003. This assessment should be reviewed and updated. Health and safety records were examined and were found to be satisfactory. Consent to use bedrails was obtained from residents relatives. There was no evidence that staff had considered the risks associated with the use of this equipment. The manager had developed a draft policy and procedure regarding the risks that staff should assess prior to using bedrails. See requirement 7. Accident records were difficult to follow, as different types of accident books were stored in different locations. The Registered Manager should ensure that accident books that are no longer in use are archived to avoid confusion. The inspector was told that there had not been any accidents in the home since the last inspection. The previous requirement in respect of this issue could not be assessed. See requirement 8. The policy and procedure file was kept in the office and was accessible to staff. Lyndhurst Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 Page 22 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 2 X X 2 STAFFING Standard No Score 27 1 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 Lyndhurst Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The Registered Person must ensure that care plans identify how service users needs are to be met. (The previous timescales of 01.11.04, 21.08.05 and 01.12.05 were not met) The Registered Person must ensure that the minimum numbers of staff as outlined in the staffing notice are provided on each shift and that the off duty roster is kept up to date. The Registered Person must ensure that staff who commence work in the home with a POVA first check are supervised. (The previous timescale of 01.11.05 was not met) The Registered Person must ensure that two written references are obtained prior to staff commencing work in the home. The Registered Person must ensure that a record of induction training is maintained and kept in the care home. (The previous timescales of
DS0000006765.V272766.R01.S.doc Timescale for action 01/03/06 2. OP27 17 & 18 01/02/06 3. OP29 19 01/02/06 4. OP29 19 01/02/06 5. OP30 17 01/03/06 Lyndhurst Nursing Home Version 5.0 Page 24 6. OP35 17(2) 7. OP38 13 8. OP38 17 01.09.05 and 01.12.05 were not met) The Registered Person must 01/02/06 ensure that adequate records are maintained for all money or other valuables deposited for safekeeping by residents or their representatives. The Registered Person must 01/03/06 ensure that potential risks are assessed, prior to using bedsides. (The previous timescales of 01.04.05, 21.08.05 and 01.12.05 were not met) The Registered Person must 21/08/05 ensure that adequate records are maintained about all accidents that occur in the care home. This requirement was set during a previous inspection but could not be assessed during this inspection, as there were no records of any accidents occurring in the home since the last inspection. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The Registered Person should amend the Service Users Guide to include the following information: The qualifications and experience of the Registered Manager and staff, details of any special needs or interests catered for and information about how the home meets the following standards 20.4, 21.4, 22.2, 22.5, 23.3 and 23.10. The Registered Person should maintain an accurate record of staff interviews and keep a copy of the homes
DS0000006765.V272766.R01.S.doc Version 5.0 Page 25 2. OP29 Lyndhurst Nursing Home 3. 4. OP30 OP33 recruitment procedure in the home. The Registered Person should ensure that staff receive induction training to National Training Organisation specification. The Registered Person should establish a system for reviewing the quality of care and nursing provided at the care home. This system must include consultation with residents and their relatives. Lyndhurst Nursing Home DS0000006765.V272766.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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