Inspection on 15/12/08 for Lyndhurst Residential Home

This inspection was carried out on 15th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lyndhurst Residential Home 26/06/08

Lyndhurst Residential Home 28/06/07

Lyndhurst Residential Home 19/06/06

Lyndhurst Residential Home 07/12/05

Lyndhurst Residential Home 30/08/05

Lyndhurst Residential Home 07/10/04

Lyndhurst Residential Home 27/08/04

Lyndhurst Residential Home 18/12/03

Lyndhurst Residential Home 24/06/03

Lyndhurst Residential Home 23/08/02

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lyndhurst Residential Home Lyndhurst Road Goring On Thames Reading RG8 9BL     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kate Harrison     Date: 1 5 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Lyndhurst Residential Home Lyndhurst Road Goring On Thames Reading RG8 9BL 01491871325 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Lyndhurst (Goring) Limited care home 23 Number of places (if applicable): Under 65 Over 65 0 0 23 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 23 23 0 The maximum number of service users to be accommodated is 23. The registered person may provide the following categories of service only : Care home only - (PC) to service users of the following gender : Either Whose promary care needs on admission to the home are within the following categories : Old age, not falling within any other category - (OP) Dementia (DE) Mental Disorder, excluding learning disability or dementia (ND) Date of last inspection Brief description of the care home Lyndhurst Residential Home is registered for 23 older persons who require personal care and accommodation. The home is privately owned and is set in the village of Goring. The accommodation is provided in a Victorian style house. The house has been altered and adapted, and many rooms are large and bright with views of the countryside and the village green. The village offers shops, pubs and cafes with transport links to Reading and Oxford. Care Homes for Older People Page 4 of 28 Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of the service was an unannounced Key Inspection, and was carried out by two inspectors over one day. We arrived at the home at 10:oo and were in the home until 17:00. It was a thorough look at how the service is doing, and took into account information provided by the service since our last visit to the service and any other information we received about the home. Three people living in the home completed our survey forms and we spoke to staff members, a visiting professional and other people living in the home. We looked at medication records, toured the home, saw care records and staff files and discussed the running of the home with the senior managers, including the registered manager. We looked at how the home is meeting the standards set by the government and in this report we make judgements about the quality of the outcomes experienced by the people living in the home. Care Homes for Older People Page 6 of 28 Following our Key Inspection in June 2008 we carried out another unannounced visit to the home on 29th August to follow up the requirements made at the Key inspection. We found that although some progress had been made that not all the requirements were met by our August visit. Again we found at this Key inspection that the requirements are still not met, and we are monitoring the home under our Enforcement procedures. The last Key Inspection of this service was 27th June 2008. The fees for the home range from GB pounds 450 to GB pounds 560 per week. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People admitted to the home cannot be sure their health and welfare needs will be met, as the pre-admission assessment is not thorough and complete. Evidence: At our last key inspection in June 2008 a requirement was made that a suitably trained member of staff must assess the care needs of people before admission to the care home. Only Julia Collyer, the registered manager, now carries out the pre-admission assessments. We looked at a recent pre-admission assessment document and spoke to the individual concerned. The pre-admission assessment document did not contain enough information to know how the health and welfare needs of the individual could be met by the home. The Past Medical History, Personal Safety and Risk, History of Falls and Mobility - Walking, areas of the form were left blank. When we spoke to the individual we heard how she/he could not stand up without help, had a history of falls and is anxious about falling again. She/he now spends all the time in the bedroom Care Homes for Older People Page 10 of 28 Evidence: because the three steps to the lift make it difficult to get around. This information was missing from the pre-admission assessment document, and there was no plan to help the individual to manage getting around the home. The individuals needs were not met as a consequence. A requirement is made about appropriate preadmission assessment. The registered manager confirmed that the home does not confirm in writing to individuals following the pre-admission assessment that the home can meet their assessed health and welfare needs, as required by regulation, and a requirement is made in this report. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The requirements made at the last inspection in June 2008 about care planning, carrying out risk assessments and meeting peoples psychological and nutritional needs have not been met, and a further requirement about medication is made. The health and welfare needs of people in the home are not recognised, documented or met, and as a result people are not safe. Evidence: At our last inspection visit in June 2008 a requirement was made about care plans having sufficient detail to ensure that all staff are familiar with the specific care needs of each person, about when care is to be provided and how. A requirement was also made about the need to include the individual or their representative in agreeing and signing and dating their care plans. Further requirements were made about monitoring the psychological and nutritional needs of people living in the home on a regular basis, and about having appropriate risk assessments in place so that all staff have a clear understanding of the purpose and benefits to the people in the home. The manager said that a new system of recording the care plans was being Care Homes for Older People Page 12 of 28 Evidence: implemented to improve recording. We looked at three care files to check that the health and welfare needs of people living in the home were met. Although some individuals have some risk assessments in place, they did not lead to care plans being developed to show that staff have sufficient detail to deliver care in the way people want. One individual had some care plans in place, but they did not reflect the main need of the individual, so did not give staff members a clear picture of the individuals needs, although a representative of the individual had signed a Confirmation of contents of care plan document. An individual who had fallen in the home nine times since January 2008 did not have a risk assessment about falling. There was no care plan about falling, and no information for staff about strategies or equipment to help minimise the risk of falls. The individual had not been referred to the Falls Clinic to prevent falling or to help prevent the risk of injury in future falls. One person used a wheelchair but there was no care plan for her/him to detail to the carers how they should help transfer the individual to bed. There is no hoist in the home, and the registered manager said this is because there is no need for it. We spoke to one individual who had been in the home for four weeks, and had difficulty moving around the home, was anxious and needed help with eating. We saw that one assessment for Mobility noted that the individual had difficulty in moving, but this section was left blank in another risk assessment. There were no care plans developed for the care of this individual, though the daily record shows that staff members were helping the individual to wash, dress and use the toilet. There were no care plans developed to help minimise anxiety or to help the individual to safely move about the home, and as a consequence the individual felt safer to stay alone in her/his bedroom. The manager said that this individual was frightened of getting into the bath, and so had washed at the sink since arriving in the home four weeks previously. We spoke to the district nurse who was visiting the home, and she confirmed that the district nursing service is happy to advise and support the home with information, equipment and documentation. She commented that one individual recently admitted had been referred to a consultant before admission to the home, but there was no reference to this in the individuals notes. The staff have received recent training about managing wounds and preventing pressure damage from the NHS nurses. We looked at the homes medication system to check how medication was managed. A requirement was made at our last inspection that staff members who administer medication must complete training to Level 2 from a credible source, and this has been met. The four members of staff who administer medication have attended appropriate training. The homes medication policy was last reviewed in October 2007, and so does not include the latest guidance of the Royal Pharmaceutical Society of GB. The medicines trolley is used to take medicines to people in the morning, to make sure they get medicines on time as prescribed. We checked the records for two individuals, and saw that the morning medication prescribed for one individual for one week ago still remained, although this was signed as given on the record. The manager said she Care Homes for Older People Page 13 of 28 Evidence: would investigate what happened and address the issue with staff. We saw that eye medication kept in the medication fridge was not dated when first opened. As this medication is not effective after a certain period it needs to be dated and a requirement is made in this report. We saw that the staff team respect the privacy of treat people in the home with respect, and the three people who completed our survey said that the staff team listen and act on what they say. As the requirements made at the last inspection in June 2008 about care planning, carrying out risk assessments and meeting peoples psychological and nutritional needs have not been met, we discussed this with the registered manager, and further enforcement action will be taken. During our visit the manager contacted the Falls Clinic, to seek advice about managing the risks of falling to several people in the home. Because of the homes inability to meet the previous requirements, we judge that the home is not able to meet the differing needs of people with cultural, physical, health or racial needs. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who have some independence are able to enjoy the activities provided, but the home does not provide sufficient support to help all the people living in the home to maximise their independence. Evidence: We discussed daily life with some of the people living in the home. People said that they went to see the nativity play in a local school and that children came to the home to sing carols. There is a regular Tai Chi class and we saw staff play games in the afternoon with some individuals. Three people returned our survey and said that there are usually activities arranged by the home that they can take part in. We saw that the activities some individuals attend are recorded in their care records, but this is not done consistently. Activities were discussed at a recent Residents Meeting, and suggestions about more activities for men, painting and music were made. Several people have dementia in the home, and there were no suitable activities suitable for them on the day of our visit, although a requirement was made at a previous inspection that a range of leisure and social activities must be on offer to suit peoples capacity. One individual told us that she/he was too fearful of falling to leave her/his bedroom so was unable to take part in activities, such as going into the garden. From Care Homes for Older People Page 15 of 28 Evidence: our survey two people said they always like the food and one said usually. One person said that the food was very good. Visitors are welcome at the home and several were visiting on the day of our visit. People are helped to practice their religion by attending local churches and ministers of religion visit the home regularly. One person told us I go to Church every Sunday, they take me. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Safeguarding Adults team is not yet satisfied with the quality of care in the home, and the home has not demonstrated that it is able to manage complaints effectively. Evidence: The homes complaints procedure is displayed in the home and the manager confirmed that no complaints had been received since our last inspection. This means that no complaints have been recorded as made to the home since 2005. Of the three people who responded to our survey they all said that they usually knew whom to talk to if they were not happy, and they all said they knew how to make a complaint. As no complaints have been recorded it has not been possible to test how responsive the homes management is to any complaints made. Most of the staff team have received in-house training about safeguarding vulnerable adults during the past year, but the home needs to be sure that the quality of the training is good by the trainers regularly attending creditable training. The homes policies and procedure about safeguarding vulnerable adults have not been updated since June 2004, and a comment was made in the last inspection report that they needed to be updated, so that all staff members are aware of any changes. The home needs to address this soon. The Oxfordshire Safeguarding team has held meetings with the home about improving the the quality of care in the home, and these meetings are not yet concluded. Care Homes for Older People Page 17 of 28 Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and hygienic but more equipment is needed to help people living in the home remain independent. Evidence: The home is comfortable and homely. We discussed the monitoring of the temperature of water used by the people living in the home with the manager. She confirmed that there is no system in place at present, and later confirmed that the home had during the day contacted the contractors who installed the temperature controll valves used in the home and a system of regular testing was agreed to start soon. We saw confirmation that the home has met the April 08 enforcement order from the Fire Authority. One of the homes bathrooms is not in use, and the other two have aids fitted to help the 18 people currently living in the home to use the bath. One individual tolds us that she/he was frightened of using the bath, and the manager needs to consider how to improve the facilities so that people living in the home can happily use them. There is no hoist in the home and the manager confirmed that there are limited aids available to help people with difficulty with movement. Three people replied to our survey question about the homes cleanliness saying it was always fresh and clean, and we noted that the home was clean and hygienic. The laundry has suitable equipment to manage the homes laundry and has handwashing Care Homes for Older People Page 19 of 28 Evidence: and drying facilities to minimise the risks of spreading infection. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to the recruitment and training systems in the home, but more progress needs to be made, to make sure that the needs of people in the home are met by safe well trained staff. Evidence: We saw the staff files of the five staff members recently recruited, to check the recruitment procedure. The home had received confirmation that the new people were not on a list of people banned from working with vulnerable people before they started working at the home, and all the new people worked under supervision until full clearance from the Criminal Record Bureau (CRB) was received. One person has not yet received full clearance and works under supervision. No references were received for one person working at the home in a non caring role, and only one reference was received for another individual. At our inspection visit in June 08 and a further visit in August 08, the home was failing to make sure that the recruitment process was robust, and although improvements have been made, the home has yet to receive the outstanding references. Progress has been made in increasing the numbers of staff members with National Vocational Qualifications (NVQ) in Care, and one more person has achieved the NVQ Level 2 in Care. One staff member is currently taking the course, and four more are booked to start in January 09. A new training package has been purchased and is being introduced to the staff members. One person has Care Homes for Older People Page 21 of 28 Evidence: received training on how to deliver the training, which is a series of workbooks with exercises to be completed. In includes induction training for new staff, and the home has an additional first day induction to the home environment for all new staff. Other health professionals have delivered training to staff, including wound management and pressure damage and fire safety training has also been delivered. he home has sourced a new provider to manage the NVQ Level 3 training in 2009. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not run in the best interests of the people living there, as the management lacks the ability to prioritise their needs. Evidence: The registered manager has worked at the home in different capacities since 2002, and became the registered manager in March 2008. She has achieved the Registered Managers Award in 2007. All the requirements made at our last key inspection of June 2008 were not met at our follow up visit in August 08, and two remain outstanding at this key inspection, about care planning and risk assessments regarding the psychological and nutritional needs of people at the care home. Another requirement about recruitment procedures has not been fully met. The pre admission assessments carried out by the registered manager are not sufficiently thorough and complete to enable the home to be sure the needs of the individual can be met in the home. We found at this inspection visit that people at risk of falling were not properly referred to appropriate professionals to minimise their risk of injury, and people were not provided Care Homes for Older People Page 23 of 28 Evidence: with the help they needed to move more independently around the home. As a consequence the people living in the home are at continuing risk to their health and safety. An annual quality assurance exercise was carried out earlier in 2008, but not sufficient information was received to be of use to the home, and the home needs to consider how to get better information to inform its quality assurance procedures. No regular audits are conducted about topics such as care planning, medication management or the environment. The registered manager is responsible for health and safety, and fire safety training was delivered to staff in October 08. We saw the homes health and safety policy statement, and noted that it refers mainly to the responsibilities of the staff. It does not detail how the home will ensure a safe environment, and this needs to be included. The home has met the enforcement order from the Fire Officer, and the monitoring of water temperatures is to start soon to make sure that people living in the home will not be scalded. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 That the registered person 26/12/2008 confirms in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service users needs in respect of his health and welfare. So that the individual knows that he can expect the home to manage his health and welfare needs properly. 2 3 14 That the needs of the 26/12/2008 service user are assessed before the registered person provides accommodation at the home. To make sure that all the needs of the individual are recognised, so that the registered person can decide whether to admit the individual or to decline the referral, if the home cannot meet the individuals needs. Care Homes for Older People Page 26 of 28 3 9 13 That the home makes suitable arrangements for the safe administration of medicines in the home. So that medicines that expire within a certain period after opening are marked with the date of opening and are discarded according to the manufacturers instructions. 19/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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