Inspection on 19/06/06 for Lyndhurst Residential Home

This inspection was carried out on 19th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Residential Home 15/12/08

Lyndhurst Residential Home 26/06/08

Lyndhurst Residential Home 28/06/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Lyndhurst Residential Home Lyndhurst Road Goring On Thames Reading RG8 9BL Lead Inspector Jane Handscombe Unannounced Inspection 19th June 2006 14:00 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 Residential Home DS0000013107.V299860.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 Residential Home DS0000013107.V299860.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lyndhurst Residential Home Address Lyndhurst Road Goring On Thames Reading RG8 9BL 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) 01491 873397 Lyndhurst (Goring) Limited Vacant Care Home 23 Category(ies) of Dementia - over 65 years of age (3), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (23) Lyndhurst Residential Home DS0000013107.V299860.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of persons that may be accommodated at any one time must not exceed 23. 7th December 2005 Date of last inspection Brief Description of the Service: Lyndhurst Residential Home is a residential home 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 for its purpose. 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. Staff are provided in adequate numbers to enable care to be provided in a relaxed manner, taking account of service users’ privacy and dignity. Fees range from £400 per week to £550 per week. Lyndhurst Residential Home DS0000013107.V299860.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’ involving one inspector, which took place over one day. The inspector arrived at the service on 19th June 2006 and was in the service for 6.25 hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s manager, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the services and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Comments received from residents included: ‘The food is marvellous, we get a choice’. ‘We are ‘treated with dignity and respect’. ‘The carers are really good, I feel very safe’. ‘My daughter is always welcomed’. ‘Staff in charge of the shift have always been polite and helpful’. Comments received from staff included: ‘The manager is very approachable’. ‘They are really nice and very good to me’. I’m always keen to learn something new’. The inspector would like to thank residents, relatives, staff and all those who kindly gave their time to help during this inspection. Lyndhurst Residential Home DS0000013107.V299860.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lyndhurst Residential Home DS0000013107.V299860.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lyndhurst Residential Home DS0000013107.V299860.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are provided with information about the home and services it is able to offer and undergo an assessment of needs prior to being offered a vacancy at the home. Following an assessment they are offered the opportunity to visit the home and experience ‘life’ at Lyndhurst, allowing them to make an informed choice as to the suitability. EVIDENCE: The home provides information in an accessible format for prospective service users looking for a home to meet their needs. All prospective service users undergo an assessment of needs prior to being offered a place, to ensure that the home can meet those assessed needs. The home encourages prospective service users to visit the home where they can spend some time at the home, meeting with fellow service users, meeting the care staff and experiencing life at the home to enable them to make an informed choice when deciding upon a home suitable for their needs. Lyndhurst Residential Home DS0000013107.V299860.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All service users’ health, personal and social care needs are set out in an individualised plan of care although they could be improved. Service users are able to maintain responsibility for their own medication, within a risk assessment framework. Service users are treated with dignity and respect at all times. EVIDENCE: A sample of service users’ care plans, drawn up from an assessment of needs, was viewed and found to be regularly updated, One care plan viewed highlighted an incidence of poor recording, in which a resident was hospitalised due to a fall, although no mention of this was made in the care plan other than the date of the resident’s return. No notification of the incident had been forwarded to CSCI as is required under the Care Homes Regulations. The manager assured the inspector that any further incidences requiring notification to the Commission for Social Care Inspection, would be forwarded without delay. Lyndhurst Residential Home DS0000013107.V299860.R01.S.doc Version 5.2 Page 10 Upon viewing the daily logs and subsequently speaking to service users, the inspector felt that there were positive outcomes taking place, although these failed to be reflected within the daily records. The inspector discussed these findings with the manager and suggested positive outcomes are recorded in the care plans. The manager agreed to reflect the positive outcomes allowing for a more person centred approach than that which is presently reflected. The home has recently undertaken to work in collaboration with the falls clinic, which work closely with the home and their service users. A falls chart was found in each service user’s care plan, which allows the home to see if a pattern builds up and should this be the case, act upon the findings. It was found that a couple of service users had suffered falls and a review of medication was undertaken which resulted in positive outcomes for each. The home has policies and procedures for the receipt, recording, storage, handling administration and disposal of medicines in the home and records of those received, administered and disposed of are kept to ensure that no mishandling takes place. From the evidence seen by the inspector and comments received, the inspector considers that this service is able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Lyndhurst Residential Home DS0000013107.V299860.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home supports residents to maintain contact with their family and friends and the local community and they are assisted to exercise choice over their day. Residents enjoy wholesome meals, which can be taken in the home’s dining room or at a place of the resident’s choosing. Every effort is made to ensure that residents enjoy their meals. EVIDENCE: Feedback from questionnaires sent to residents, Health and social care professionals and visitors informed the inspector that the provision of regular activities was an area of concern. Upon discussion with the manager it was ascertained that whilst the home does not employ an activities co-ordinator, this had been an area of concern and recently addressed. Staffing levels had been recently increased, beginning the week prior to this unannounced inspection, to allow the staff to undertake more activities with service users, both on a one to one basis and within groups, to suit service users’ preferences. Speaking with residents and staff it was apparent that daily Lyndhurst Residential Home DS0000013107.V299860.R01.S.doc Version 5.2 Page 12 activities include indoor skittles, bingo, board games, art and craft and chair exercises. The home welcomes visitors at any reasonable time and service users are encouraged to maintain links with family/friends/representatives and the local community as they wish. A group of ladies from the local church, who call themselves ‘the singing angels’, visit the home and join the residents in singing activities. Once a month, a local vicar visits the home and undertakes a Holy Communion service for those who wish to attend. Likewise a Catholic priest visits the home, on a fortnightly basis to undertake blessings and a service for those who require it. The home accesses a local stroke club and a social club in Goring enabling residents to partake in activities within the wider community. On the day of the inspection, residents enjoyed a lunch consisting of pork and apple casserole, new potatoes, cauliflower, peas and courgettes followed by a choice of lemon mousse, strawberries and cream, trifle or pears and chocolate sponge with cream. Meals can be taken in the home’s dining room or at a place of the resident’s choosing, as was confirmed by one resident who informed the inspector that ‘I eat my meals in my room, I’d rather be on my own’ Feedback gained from service users, spoken to on the day of inspection, around food was very positive. Service users’ likes and dislikes are respected with a choice being offered at all times. Lyndhurst Residential Home DS0000013107.V299860.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is an appropriate complaints procedure in place, which residents and staff are aware of. Service users are protected from abuse through the home’s policies, procedures and staff training. EVIDENCE: Speaking with residents on the day, it was apparent that they were aware of the complaints procedure and were confident that any concerns they may have would be acted upon appropriately. All residents spoken to were aware of who to take any concerns to if the need should arise. The inspector was alerted to an incident, which had taken place, and whilst the home undertook appropriate actions, the complaint had not been logged in the complaints book. The home has policies and procedures in place to deal with any allegations or potential issues of abuse. Training is provided to all members of staff to enable them to recognise signs and symptoms of abuse and emphasises each staff member’s responsibility to ‘whistle blow’ on any poor practice or concerns that come to their attention; this was confirmed through discussions with staff members during the inspection. There has been an allegation made since the last inspection, which the home is currently investigating. The manager and inspector discussed the Oxfordshire Lyndhurst Residential Home DS0000013107.V299860.R01.S.doc Version 5.2 Page 14 multi-agency codes of practice and it was recommended that a copy be obtained for future reference. Likewise, where potential cases are identified, that the home links in with the local authority for guidance and advice. No complainant has brought information to the Commission concerning complaints and allegations in relation to the service. Information about a concern, which was brought to the Commission, has been resolved appropriately by the home. Lyndhurst Residential Home DS0000013107.V299860.R01.S.doc Version 5.2 Page 15 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, 21 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally well maintained and provides a safe, comfortable environment for those who live there. On the whole, the home presents as clean, pleasant and hygienic, although a couple of bedrooms did present with an odour, one of which the manager was aware of and dealing with. EVIDENCE: Generally the home presented as clean, pleasant and hygienic, however two bedrooms did present with an odour. Upon discussion with the manager, it was noted that the manager was aware of one of these rooms, and a new carpet is being purchased; it was agreed that the manager would rectify the offensive odour in the other bedroom. Lyndhurst Residential Home DS0000013107.V299860.R01.S.doc Version 5.2 Page 16 One resident said how much she enjoyed spending time out in the garden and was seen in the garden during the visit. The home provides sufficient toilet and washing facilities for the number of residents, however one WC was found to contain soap bars and the manager was reminded that she should remove these and continue to use liquid soap in all communal WC and bathing facilities so as to avoid cross infection. The manager agreed to remove the soap bars and remind staff of the importance of residents not sharing soap tablets. Whilst touring the home, it was observed that a wheelchair was being stored behind a fire exit door. The home must store wheelchairs appropriately to allow access to fire escape exits and safe access to all communal areas within the home. Lyndhurst Residential Home DS0000013107.V299860.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Practices around the recruitment and training of staff compromises service users’ health, safety and welfare. EVIDENCE: The staffing levels on the day of inspection were sufficient to meet the needs of the residents. The recruitment systems in place are of a poor quality; 4 staff files were sampled for inspection. One staff member’s personnel file informed the inspector that the home had failed to gain a second written reference. All four personnel files viewed contained written references obtained via fax, which failed to inform of the company/organisation who had given the references. No verbal contact had been made to verify and validate these. Whilst the home is provided with staff via an employment agency that undertakes checks, it is the home’s responsibility to assure themselves and evidence that the agency’s recruitment procedures are robust and in line with those set out in the national minimum standards. There was no evidence that this was the case. The inspector was informed that all staff undergo an induction and are provided with further training in order that they have the skills and knowledge to undertake their role competently. All new staff undergo an induction period Lyndhurst Residential Home DS0000013107.V299860.R01.S.doc Version 5.2 Page 18 and shadow an experienced carer for a month. Likewise, updating of staff members’ training is provided along with any specialist training identified. However, the inspector sampled four staff members’ personnel files and of the four files viewed, two failed to evidence that the staff had actually undergone any induction training or supervision to give them the competencies to undertake their caring roles. A requirement has been made to address this issue. Upon discussion with the manager, the inspector was informed that a training matrix is in the process of being devised to allow for identification of staff who require any specific training or updates to the skills that they already possess. Lyndhurst Residential Home DS0000013107.V299860.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and staff reported they had a good relationship with the new manager. The home has a good system for gaining feedback from service users and their families, although this could be improved to include visitors and health and care staff who have contact with the home. In view of the findings during the inspection around the recruitment of staff and training, the home is not presently protecting the health, safety and welfare of the residents adequately and is therefore not being run in the best interests of those using the service. The home does not undertake any responsibilities in regard to residents’ finances; this is dealt with by their families. Lyndhurst Residential Home DS0000013107.V299860.R01.S.doc Version 5.2 Page 20 EVIDENCE: The home has a new manager in place who is currently seeking to undergo the registration process with the Commission for Social Care Inspection. She has worked at Lyndhurst for a number of years and has a good overall knowledge of the residents and their needs. She is presently undertaking NVQ level 4 in care, and anticipates undertaking the Registered Managers’ Award upon completion. Discussions with service users and staff informed the inspector that there was a good rapport with the manager and they felt that she ran the home in an appropriate manner. The home undertakes a quality assessment on an annual basis where they send out questionnaires to service users and family members to gain feedback on the quality of services offered. Upon discussion, it was agreed that questionnaires be offered to visitors, friends and health and care professionals involved within the home to gain a wider view. Safeguards to protect service users need to be in place and for the recruitment of staff to be done in a robust manner. The staff handover was being undertaken in a communal room, which the inspector felt inappropriate since residents were within hearing distance and therefore this could compromise confidentiality. The manager agreed to undertake these, in future, in her office. Information in the residents charter and displayed upon the notice board relating to the registration authority needs to be amended to reflect the newer body, that of the Commission for Social Care Inspection. Lyndhurst Residential Home DS0000013107.V299860.R01.S.doc Version 5.2 Page 21 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 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X 3 X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Lyndhurst Residential Home DS0000013107.V299860.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? 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 OP29 Regulation 19 Schedule 2 19 Schedule 2 18 Requirement The provider must ensure that thorough recruitment procedures are undertaken for all staff recruited either by the home or the agency. The manager must obtain a second reference with regard to the identified member of staff. The manager must ensure that all staff are suitably trained to undertake their role competently and that records of this training are kept. Timescale for action 16/07/06 2 3 OP29 OP30 31/07/06 08/08/06 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 OP16 Good Practice Recommendations It is a good practice recommendation that records in care plans also include positive outcomes and achievements. It is recommended that the residents charter be amended to reflect the newer regulatory body - Comission for Social Care Inspection DS0000013107.V299860.R01.S.doc Version 5.2 Page 23 Lyndhurst Residential Home 3 OP18 4 OP21 5 OP38 It is reccommended that the manager acquires a copy of the Oxfordshire multi agency codes of practice and links in with the local authority when dealing with any allegations of abuse. It is a good practice recommendation to ensure tablet soap is removed from all communal bathing and toileting facilities, and the provision of liquid soap remains available. It is recommended that the home ensures that wheelchairs are stored appropriately to allow easy access to fire exits without obtrusion, thereby ensuring their health safety and welfare. Lyndhurst Residential Home DS0000013107.V299860.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South, Cowley Oxford OX4 2SU 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 Residential Home DS0000013107.V299860.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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